{"hospital_name":"Providence Health And Services - Washington","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Providence St Joseph Hospital"],"hospital_address":["500 E Webster, Chewelah, WA 99109"],"license_information":{"license_number":"HAC.FS.00000194","state":"WA"},"type_2_npi":["1750532321","1902058399","1447402839"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Justin Voelker"},"financial_aid_policy":["30% off of standard gross charges."],"standard_charge_information":[{"description":"HC NDL BIOP COAX ACHIEVE 14G 11CM CA1411","code_information":[{"code":"Px0000128898L","type":"CDM"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DIL BLN CRE 18/19/20MM EA M00558380","code_information":[{"code":"Px0000129639L","type":"CDM"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BRACE UE/FX ORTHOSIS HUMERAL L3980","code_information":[{"code":"Px0000235427L","type":"CDM"},{"code":"L3980","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":597.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CATH PICC PWR TLS DL 5FR FULL","code_information":[{"code":"Px0000266150L","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ELECTRODE RESUS ZOLL ADULT HC","code_information":[{"code":"Px0000330139L","type":"CDM"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLIP CELEROMARK","code_information":[{"code":"Px0000346746L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MARKER BIOP SECURMARK EVIVA 2 SMARKEVIVA2S13","code_information":[{"code":"Px0000349452L","type":"CDM"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +4 10ML 9390110","code_information":[{"code":"Px0000375923L","type":"CDM"}],"standard_charges":[{"gross_charge":27.82,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +4 20ML 9390120","code_information":[{"code":"Px0000375924L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +6 30ML 9390130","code_information":[{"code":"Px0000375925L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +8 40ML 9390140","code_information":[{"code":"Px0000375926L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +10 50ML 9390150","code_information":[{"code":"Px0000375927L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACTA CREAM 10ML CALORIC FORTIFIER","code_information":[{"code":"Px0000463588L","type":"CDM"}],"standard_charges":[{"gross_charge":17.8,"discounted_cash":12.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACT RTF 26 100ML 95026100","code_information":[{"code":"Px0000616189L","type":"CDM"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":6.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACT RTF 28 100ML 95028100","code_information":[{"code":"Px0000616190L","type":"CDM"}],"standard_charges":[{"gross_charge":11.57,"discounted_cash":8.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN FORTIFIER PROLACT +6 15ML 9390115","code_information":[{"code":"Px0000717862L","type":"CDM"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MILK HUMAN PROLACT RTF 24 100ML 95024100","code_information":[{"code":"Px0001012655L","type":"CDM"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":4.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE","code_information":[{"code":"Px00012010001","type":"CDM"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":900.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE SWING BED","code_information":[{"code":"Px00012010004","type":"CDM"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":900.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE MED SURG W/ TELE","code_information":[{"code":"Px00012010009","type":"CDM"}],"standard_charges":[{"gross_charge":1806.0,"discounted_cash":1264.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC R&B-SEMI-PRIVATE ISOLATION","code_information":[{"code":"Px00012010011","type":"CDM"}],"standard_charges":[{"gross_charge":1286.0,"discounted_cash":900.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LEAVE OF ABSENCE NO CHRG","code_information":[{"code":"Px00018010001","type":"CDM"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC R&B ADMINISTRATIVE DAYS WA CDM","code_information":[{"code":"Px00019110002","type":"CDM"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":409.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INTENSIVE CARE INTERMEDIATE","code_information":[{"code":"Px00020610001","type":"CDM"}],"standard_charges":[{"gross_charge":1753.0,"discounted_cash":1227.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW PICC OR NONIMPLANTED CENTRAL LINE CDM","code_information":[{"code":"Px00026010006","type":"CDM"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IV HYDRATION INITIAL HR CDM","code_information":[{"code":"Px00026010007","type":"CDM"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IV HYDRATION EACH ADDL HR CDM","code_information":[{"code":"Px00026010008","type":"CDM"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION INITIAL HR CDM","code_information":[{"code":"Px00026010009","type":"CDM"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION EA ADDL HR CDM","code_information":[{"code":"Px00026010010","type":"CDM"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION SEQUENTIAL DRUG 1ST HR","code_information":[{"code":"Px00026010011","type":"CDM"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IV INFUSION CONCURRENT DRUG CDM","code_information":[{"code":"Px00026010012","type":"CDM"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ATTEMPT PICC W/IMG W/RS&I 5 YR/>","code_information":[{"code":"Px00026010030","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":1012.0,"discounted_cash":708.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ATTEMPT MIDLINE 5 YR/>","code_information":[{"code":"Px00026010031","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COVID PPE WA STATE ONLY SBR 5169","code_information":[{"code":"Px00027000011","type":"CDM"},{"code":"99072","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":4.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NITRIC OXIDE THERAPY HOURLY CDM","code_information":[{"code":"Px00027010142","type":"CDM"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WRIST SPLINT/VELCRO","code_information":[{"code":"Px00027410120","type":"CDM"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EO WITHJOINT  PREFABRICATED","code_information":[{"code":"Px00027410169","type":"CDM"},{"code":"L3760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1597.0,"discounted_cash":1117.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLEX GLOVE W/ELASTIC FINGER","code_information":[{"code":"Px00027410170","type":"CDM"},{"code":"L3912","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SEWHO CAP DESIGN W/O JNTS CF","code_information":[{"code":"Px00027410171","type":"CDM"},{"code":"L3961","type":"HCPCS"}],"standard_charges":[{"gross_charge":2281.0,"discounted_cash":1596.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SO AIRPLANE W/WO JOINT CF","code_information":[{"code":"Px00027410172","type":"CDM"},{"code":"L3674","type":"HCPCS"}],"standard_charges":[{"gross_charge":1521.0,"discounted_cash":1064.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WHFO NONTORSION JOINT PREFAB","code_information":[{"code":"Px00027410173","type":"CDM"},{"code":"L3931","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SO SHLDR CAP NO JOINTS CSTM","code_information":[{"code":"Px00027410235","type":"CDM"},{"code":"L3671","type":"HCPCS"}],"standard_charges":[{"gross_charge":1223.0,"discounted_cash":856.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EO  NO JOINTS  CUSTOM","code_information":[{"code":"Px00027410236","type":"CDM"},{"code":"L3702","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EWHO RIGID NO JOINTS  CUSTOM","code_information":[{"code":"Px00027410237","type":"CDM"},{"code":"L3763","type":"HCPCS"}],"standard_charges":[{"gross_charge":1004.0,"discounted_cash":702.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EWHO W/JOINTS W/BANDS CSTM","code_information":[{"code":"Px00027410238","type":"CDM"},{"code":"L3764","type":"HCPCS"}],"standard_charges":[{"gross_charge":689.0,"discounted_cash":482.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WHFO W/JOINTS W/BANDS CSTM","code_information":[{"code":"Px00027410240","type":"CDM"},{"code":"L3806","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":436.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HFO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410243","type":"CDM"},{"code":"L3913","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":335.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HAND ORTHOTIC -  NO JOINTS CUSTOM","code_information":[{"code":"Px00027410244","type":"CDM"},{"code":"L3919","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HFO W/JOINTS W/BANDS CUSTOM","code_information":[{"code":"Px00027410245","type":"CDM"},{"code":"L3921","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":443.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FO NO JOINTS CUSTOM","code_information":[{"code":"Px00027410246","type":"CDM"},{"code":"L3933","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FO  W/JOINTS  CUSTOM","code_information":[{"code":"Px00027410247","type":"CDM"},{"code":"L3935","type":"HCPCS"}],"standard_charges":[{"gross_charge":2281.0,"discounted_cash":1596.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FO PIP/DIP WITH JOINT/SPRING","code_information":[{"code":"Px00027410292","type":"CDM"},{"code":"L3925","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISCELLANEOUS BODY FLUIDS LAB","code_information":[{"code":"Px00030000003","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000004","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID LAB","code_information":[{"code":"Px00030000006","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISCELLANEOUS BODY FLUIDS LAB","code_information":[{"code":"Px00030000007","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000008","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT LAB","code_information":[{"code":"Px00030000010","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SWEAT COLLECTION IONTOPHORESIS LAB","code_information":[{"code":"Px00030000013","type":"CDM"},{"code":"89230","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FAT STAIN FECES URINE/RESPIR SECRETIONS LAB","code_information":[{"code":"Px00030000014","type":"CDM"},{"code":"89125","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW VENIPUNCTURE CDM","code_information":[{"code":"Px00030010004","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM","code_information":[{"code":"Px00030010009","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLLECTION CAPILLARY BLOOD SPECIMEN","code_information":[{"code":"Px00030010011","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX CDM","code_information":[{"code":"Px00030010013","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA DNA/RNA RSV AMPLIFIED PROBE TECHNIQUE LAB","code_information":[{"code":"Px00030010015","type":"CDM"},{"code":"87634","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":312.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 CDM","code_information":[{"code":"Px00030010043","type":"CDM"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC KRAS GENE ANALYSIS VARIANTS IN EXON 2 LAB","code_information":[{"code":"Px00030010045","type":"CDM"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BRAF GENE ANALYSIS V600 VARIANT(S) LAB","code_information":[{"code":"Px00030010050","type":"CDM"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":290.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLT3MT MUTATION DETECTION","code_information":[{"code":"Px00030010053","type":"CDM"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.0,"discounted_cash":513.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLU A FLU B AND RSV BY PCR","code_information":[{"code":"Px00030010068","type":"CDM"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ADENOVIRUS DNA QNT","code_information":[{"code":"Px00030010072","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH CDM","code_information":[{"code":"Px00030010093","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM CDM","code_information":[{"code":"Px00030010099","type":"CDM"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET LAB","code_information":[{"code":"Px00030010191","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":286.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGFR GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00030010228","type":"CDM"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS CDM","code_information":[{"code":"Px00030010260","type":"CDM"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":437.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET CDM","code_information":[{"code":"Px00030010262","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":1221.0,"discounted_cash":854.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BCR/ABL TRANSLOCATION MAJOR BREAKPOINT LAB","code_information":[{"code":"Px00030010266","type":"CDM"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":237.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC F2 GENE ANALYSIS 20210G >A VARIANT CDM","code_information":[{"code":"Px00030010267","type":"CDM"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT LAB","code_information":[{"code":"Px00030010269","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MTHFR GENE ANALYSIS COMMON VARIANTS CDM","code_information":[{"code":"Px00030010270","type":"CDM"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE","code_information":[{"code":"Px00030010271","type":"CDM"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FACTOR V LEIDEN GENE ANALYSIS","code_information":[{"code":"Px00030010272","type":"CDM"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYSTIC FIBROSIS GENE ANALYSIS","code_information":[{"code":"Px00030010276","type":"CDM"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":543.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS CDM","code_information":[{"code":"Px00030010279","type":"CDM"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE CDM","code_information":[{"code":"Px00030010281","type":"CDM"},{"code":"89055","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IGK GENE REARRANGE B CELL CLON LAB","code_information":[{"code":"Px00030010291","type":"CDM"},{"code":"81264","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS CDM","code_information":[{"code":"Px00030010293","type":"CDM"},{"code":"81310","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST CDM","code_information":[{"code":"Px00030010368","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES","code_information":[{"code":"Px00030010409","type":"CDM"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":272.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET ANTIBODIES CDM","code_information":[{"code":"Px00030010413","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":286.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM","code_information":[{"code":"Px00030010421","type":"CDM"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH CDM","code_information":[{"code":"Px00030010427","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY","code_information":[{"code":"Px00030010429","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC C-1-ESTERASE INHIB FUNC(ARUP)","code_information":[{"code":"Px00030010431","type":"CDM"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT CDM","code_information":[{"code":"Px00030010433","type":"CDM"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CCP ANTIBODY","code_information":[{"code":"Px00030010438","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DEOXYRIBONUCLEASE ANTIBODY","code_information":[{"code":"Px00030010447","type":"CDM"},{"code":"86215","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - MISC","code_information":[{"code":"Px00030010450","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - PURKINJE","code_information":[{"code":"Px00030010451","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030010453","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION OUCHTERLONY","code_information":[{"code":"Px00030010463","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CDM","code_information":[{"code":"Px00030010472","type":"CDM"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN AB","code_information":[{"code":"Px00030010495","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY TITER - MISC ANTI","code_information":[{"code":"Px00030010507","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":471.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMAGGLUTINATION INHIBITION","code_information":[{"code":"Px00030010549","type":"CDM"},{"code":"86280","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 CDM","code_information":[{"code":"Px00030010554","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR CA 15-3 CA 27.29","code_information":[{"code":"Px00030010556","type":"CDM"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR CA 19-9","code_information":[{"code":"Px00030010558","type":"CDM"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM","code_information":[{"code":"Px00030010560","type":"CDM"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CDM","code_information":[{"code":"Px00030010567","type":"CDM"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION OUCHTERLONY - GEL DIFFUSION","code_information":[{"code":"Px00030010585","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNE COMPLEX ASSAY CDM","code_information":[{"code":"Px00030010589","type":"CDM"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS SERUM","code_information":[{"code":"Px00030010599","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNFIX E-PHORSIS/URINE/CSF","code_information":[{"code":"Px00030010605","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNFIX E-PHORSIS/URINE/CSF - FLUIDS","code_information":[{"code":"Px00030010608","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INSULIN ANTIBODIES CDM","code_information":[{"code":"Px00030010617","type":"CDM"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY IGG(ARUP)","code_information":[{"code":"Px00030010621","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY CDM","code_information":[{"code":"Px00030010623","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT CDM","code_information":[{"code":"Px00030010630","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC B CELLS TOTAL COUNT","code_information":[{"code":"Px00030010637","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NK CELLS TOTAL COUNT","code_information":[{"code":"Px00030010641","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT","code_information":[{"code":"Px00030010646","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T CELL ABSOLUTE COUNT/RATIO","code_information":[{"code":"Px00030010648","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T CELL ABSOLUTE COUNT/RATIO - HELPER SUPPRESSOR","code_information":[{"code":"Px00030010649","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T CELL ABSOLUTE COUNT","code_information":[{"code":"Px00030010657","type":"CDM"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH CDM","code_information":[{"code":"Px00030010660","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH CDM","code_information":[{"code":"Px00030010661","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODY","code_information":[{"code":"Px00030010663","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TB INTRADERMAL TEST - PPD","code_information":[{"code":"Px00030010683","type":"CDM"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SKIN TEST TUBERCULOSIS INTRADERMAL CDM","code_information":[{"code":"Px00030010684","type":"CDM"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BACTERIUM ANTIBODY","code_information":[{"code":"Px00030010696","type":"CDM"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLASTOMYCES ANTIBODY","code_information":[{"code":"Px00030010706","type":"CDM"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LYME DISEASE ANTIBODY-WESTERN BLOT","code_information":[{"code":"Px00030010725","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LYME DISEASE ANTIBODY - CSF","code_information":[{"code":"Px00030010727","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LYME DISEASE ANTIBODY","code_information":[{"code":"Px00030010731","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORRELIA RELAPSING FEVER CDM","code_information":[{"code":"Px00030010733","type":"CDM"},{"code":"86619","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":316.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CANDIDA CDM","code_information":[{"code":"Px00030010736","type":"CDM"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COXIELLA BURNETII Q FEVER CDM","code_information":[{"code":"Px00030010743","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CRYPTOCOCCUS CDM","code_information":[{"code":"Px00030010747","type":"CDM"},{"code":"86641","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV CDM","code_information":[{"code":"Px00030010751","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CMV ANTIBODY","code_information":[{"code":"Px00030010753","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CMV ANTIBODY-MISC","code_information":[{"code":"Px00030010759","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV IGM CDM","code_information":[{"code":"Px00030010764","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CMV ANTIBODY IGM","code_information":[{"code":"Px00030010765","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN-BARR ANTIBODY EARLY ANTIGEN","code_information":[{"code":"Px00030010809","type":"CDM"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN","code_information":[{"code":"Px00030010814","type":"CDM"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":531.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID","code_information":[{"code":"Px00030010822","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID IGG","code_information":[{"code":"Px00030010823","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID IGM","code_information":[{"code":"Px00030010824","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY GIARDIA LAMBLIA CDM","code_information":[{"code":"Px00030010839","type":"CDM"},{"code":"86674","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":459.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HELICOBACTER PYLORI CDM","code_information":[{"code":"Px00030010844","type":"CDM"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HELICOBACTER PYLORI","code_information":[{"code":"Px00030010846","type":"CDM"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HELMINTH ANTIBODY","code_information":[{"code":"Px00030010853","type":"CDM"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HTLV/HIV CONFIRMATORY TEST","code_information":[{"code":"Px00030010865","type":"CDM"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST CDM","code_information":[{"code":"Px00030010869","type":"CDM"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST CDM","code_information":[{"code":"Px00030010875","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST CDM","code_information":[{"code":"Px00030010878","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 1 CDM","code_information":[{"code":"Px00030010889","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY PARVOVIRUS CDM","code_information":[{"code":"Px00030010894","type":"CDM"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 1 CDM","code_information":[{"code":"Px00030010897","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HERPES SIMPLEX TYPE 2","code_information":[{"code":"Px00030010903","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HERPES SIMPLEX TYPE 2 - TYPE 2 IGG","code_information":[{"code":"Px00030010906","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 2 CDM","code_information":[{"code":"Px00030010911","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HISTOPLASMA CDM","code_information":[{"code":"Px00030010914","type":"CDM"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HIV- 2","code_information":[{"code":"Px00030010922","type":"CDM"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":294.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY CDM","code_information":[{"code":"Px00030010926","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS BE ANTIBODY HBEAB CDM","code_information":[{"code":"Px00030010928","type":"CDM"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY CDM","code_information":[{"code":"Px00030010931","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA VIRUS ANTIBODY","code_information":[{"code":"Px00030010934","type":"CDM"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LEGIONELLA ANTIBODY","code_information":[{"code":"Px00030010936","type":"CDM"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBEOLA CDM","code_information":[{"code":"Px00030010970","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TOXOPLASMA ANTIBODY","code_information":[{"code":"Px00030010982","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA CDM","code_information":[{"code":"Px00030010984","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA IGM CDM","code_information":[{"code":"Px00030010990","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM CDM","code_information":[{"code":"Px00030010996","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VARICELLA-ZOSTER ANTIBODY - IGG","code_information":[{"code":"Px00030011003","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011004","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011006","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011008","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VARICELLA-ZOSTER CDM","code_information":[{"code":"Px00030011011","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VARICELLA-ZOSTER ANTIBODY - AB","code_information":[{"code":"Px00030011012","type":"CDM"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY ANTIBODIES","code_information":[{"code":"Px00030011017","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY SCREEN","code_information":[{"code":"Px00030011019","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES","code_information":[{"code":"Px00030011023","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOLOGY PROCEDURE","code_information":[{"code":"Px00030011035","type":"CDM"},{"code":"86849","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE LAB","code_information":[{"code":"Px00030011040","type":"CDM"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY CDM","code_information":[{"code":"Px00030011045","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ LAB","code_information":[{"code":"Px00030011046","type":"CDM"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DIRECT COOMBS","code_information":[{"code":"Px00030011070","type":"CDM"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE ADDL","code_information":[{"code":"Px00030011072","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER LAB","code_information":[{"code":"Px00030011079","type":"CDM"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO LAB","code_information":[{"code":"Px00030011083","type":"CDM"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA","code_information":[{"code":"Px00030011098","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA","code_information":[{"code":"Px00030011108","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR EA - SCREEN EA UNIT","code_information":[{"code":"Px00030011110","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS","code_information":[{"code":"Px00030011114","type":"CDM"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ANTIGLOBULIN LAB","code_information":[{"code":"Px00030011123","type":"CDM"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT ELECTRONIC LAB","code_information":[{"code":"Px00030011125","type":"CDM"},{"code":"86923","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOLYSINS&AGGLUTININS INCUBATED LAB","code_information":[{"code":"Px00030011129","type":"CDM"},{"code":"86941","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IRRADIATION BLOOD PRODUCT EACH UNIT LAB","code_information":[{"code":"Px00030011130","type":"CDM"},{"code":"86945","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PRETX RBC ANTIBODY INCUBAT W/ENZYMES EACH LAB","code_information":[{"code":"Px00030011132","type":"CDM"},{"code":"86971","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.4,"discounted_cash":299.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PRETX SERUM RBC ANTB ID INCUBATION INHIBITORS EA LAB","code_information":[{"code":"Px00030011135","type":"CDM"},{"code":"86977","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.4,"discounted_cash":299.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RBC PRETREATMENT SERUM - EACH CELL","code_information":[{"code":"Px00030011136","type":"CDM"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RBC PRETREATMENT SERUM - ABSORPTION","code_information":[{"code":"Px00030011137","type":"CDM"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPECIMEN CONCENTRATION","code_information":[{"code":"Px00030011141","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTR BACTERIA EXCEPT BLOOD","code_information":[{"code":"Px00030011159","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE MYCOPLASMA ANY SOURCE CDM","code_information":[{"code":"Px00030011166","type":"CDM"},{"code":"87109","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA CULTURE","code_information":[{"code":"Px00030011169","type":"CDM"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MYCOBACTERIC IDENTIFICATION","code_information":[{"code":"Px00030011172","type":"CDM"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM CDM","code_information":[{"code":"Px00030011179","type":"CDM"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MACROSCOPIC EXAM PARASITE","code_information":[{"code":"Px00030011197","type":"CDM"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OVA AND PARASITES SMEARS","code_information":[{"code":"Px00030011200","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MICROBE SUSCEPT MACROBROTH - AFB SENS  EA AGENT","code_information":[{"code":"Px00030011216","type":"CDM"},{"code":"87188","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMEAR FLUORESCENT/ACID STAI","code_information":[{"code":"Px00030011226","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT CDM","code_information":[{"code":"Px00030011236","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMEAR FLUORESCENT/ACID STAIN- FUNGUS","code_information":[{"code":"Px00030011244","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00030011248","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00030011249","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMEAR SPECIAL STAIN - PARASITES","code_information":[{"code":"Px00030011250","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMEAR COMPLEX STAIN-TRICHROME/OVA/PARA","code_information":[{"code":"Px00030011257","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMEAR COMPLEX STAIN","code_information":[{"code":"Px00030011258","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMEAR WET MOUNT SALINE/INK - KOH EXAM","code_information":[{"code":"Px00030011260","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT LAB","code_information":[{"code":"Px00030011261","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT CDM","code_information":[{"code":"Px00030011273","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY TOXIN OR ANTITOXIN","code_information":[{"code":"Px00030011274","type":"CDM"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VIRUS INOCULATION TISSUE - HERPES CULTURE","code_information":[{"code":"Px00030011279","type":"CDM"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VIRUS INOCULATION TISSUE","code_information":[{"code":"Px00030011280","type":"CDM"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VIRUS INOCULATION TISSUE - VIRAL CULTURE","code_information":[{"code":"Px00030011289","type":"CDM"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VIRUS INOCULATE TISSUE ADDL","code_information":[{"code":"Px00030011295","type":"CDM"},{"code":"87253","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VIRUS INOCULATION SHELL VIA","code_information":[{"code":"Px00030011304","type":"CDM"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ADENOVIRUS INFECTIOUS AGENT","code_information":[{"code":"Px00030011309","type":"CDM"},{"code":"87260","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA B AG IF","code_information":[{"code":"Px00030011318","type":"CDM"},{"code":"87275","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA A AG IF","code_information":[{"code":"Px00030011321","type":"CDM"},{"code":"87276","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":132.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LEGION PNEUMOPHILIA AG IF","code_information":[{"code":"Px00030011323","type":"CDM"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PARAINFLUENZA AG IF","code_information":[{"code":"Px00030011326","type":"CDM"},{"code":"87279","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAADI RESPIRATORY SYNCTIAL VIRUS CDM","code_information":[{"code":"Px00030011328","type":"CDM"},{"code":"87280","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAADI PNEUMOCUSTIS CARINII CDM","code_information":[{"code":"Px00030011331","type":"CDM"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PNEUMOCYSTIS-DIRECT FA","code_information":[{"code":"Px00030011332","type":"CDM"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AG DETECTION POLYVAL IF - INFECTIOUS AGENT","code_information":[{"code":"Px00030011347","type":"CDM"},{"code":"87300","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRYPTOCOCCUS NEOFORM AG EIA","code_information":[{"code":"Px00030011352","type":"CDM"},{"code":"87327","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRYPTOSPORIDIUM AG EIA","code_information":[{"code":"Px00030011355","type":"CDM"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG","code_information":[{"code":"Px00030011359","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TRICHINELLA CDM","code_information":[{"code":"Px00030011371","type":"CDM"},{"code":"86784","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING GLC/HPLC","code_information":[{"code":"Px00030011378","type":"CDM"},{"code":"87143","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES SCREEN - REFLEXIVE","code_information":[{"code":"Px00030011393","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS BE ANTIGEN CDM","code_information":[{"code":"Px00030011397","type":"CDM"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM CDM","code_information":[{"code":"Px00030011405","type":"CDM"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC STREP TEST RAPID","code_information":[{"code":"Px00030011409","type":"CDM"},{"code":"87430","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA B PARAPERT/B PERTUSSIS AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030011420","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BAL-OIL RED O STAIN","code_information":[{"code":"Px00030011423","type":"CDM"},{"code":"89125","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA BK VIRUS QUANTIFICATION EACH ORGANISM CDM","code_information":[{"code":"Px00030011426","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BK VIRUS QUANT PCR URINE","code_information":[{"code":"Px00030011428","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BK VIRUS URINE VIRACOR","code_information":[{"code":"Px00030011429","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE - EA","code_information":[{"code":"Px00030011463","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT CDM","code_information":[{"code":"Px00030011479","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ENA LAB","code_information":[{"code":"Px00030011488","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - RIBOSOMAL PROTEIN","code_information":[{"code":"Px00030011493","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN","code_information":[{"code":"Px00030011497","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN DIPTHERIA CDM","code_information":[{"code":"Px00030011501","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY CDM","code_information":[{"code":"Px00030011511","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC POOLING PLATELETS/OTHER BLOOD PRODUCTS LAB","code_information":[{"code":"Px00030011514","type":"CDM"},{"code":"86965","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BODY FLUID CELL COUNT","code_information":[{"code":"Px00030011519","type":"CDM"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BODY FLUID CELL COUNT W/ DIFFERENTIAL","code_information":[{"code":"Px00030011520","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BODY FLUID CELL COUNT W/ DIFFERENTIAL CSF","code_information":[{"code":"Px00030011521","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BORDETELLA PERTUSSIS PCR","code_information":[{"code":"Px00030011530","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA CANDIDA SPECIES DIRECT PROBE TQ CDM","code_information":[{"code":"Px00030011540","type":"CDM"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CCD3 FLOW","code_information":[{"code":"Px00030011542","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD10 FLOW","code_information":[{"code":"Px00030011543","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD117 FLOW","code_information":[{"code":"Px00030011544","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD11B FLOW","code_information":[{"code":"Px00030011545","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD13 FLOW","code_information":[{"code":"Px00030011546","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD138 FLOW","code_information":[{"code":"Px00030011547","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD14 FLOW","code_information":[{"code":"Px00030011548","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD14MO2 FLOW","code_information":[{"code":"Px00030011549","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD15 FLOW","code_information":[{"code":"Px00030011551","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD19 FLOW","code_information":[{"code":"Px00030011552","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD20 FLOW","code_information":[{"code":"Px00030011553","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD25 FLOW","code_information":[{"code":"Px00030011555","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD33 FLOW","code_information":[{"code":"Px00030011556","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD34 FLOW","code_information":[{"code":"Px00030011557","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD38 FLOW","code_information":[{"code":"Px00030011559","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD41 FLOW","code_information":[{"code":"Px00030011562","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD56 FLOW","code_information":[{"code":"Px00030011563","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD57 FLOW","code_information":[{"code":"Px00030011564","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD64 FLOW","code_information":[{"code":"Px00030011565","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD7 FLOW","code_information":[{"code":"Px00030011566","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD8 FLOW","code_information":[{"code":"Px00030011567","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA PNEUM DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030011570","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA TRACHOMATIS PCR","code_information":[{"code":"Px00030011572","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE","code_information":[{"code":"Px00030011574","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME ANALYSIS 45 CELLS MOSAICISM","code_information":[{"code":"Px00030011575","type":"CDM"},{"code":"88263","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":429.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME ANALYSIS COMPLETE","code_information":[{"code":"Px00030011577","type":"CDM"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.0,"discounted_cash":824.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHRMSM COUNT 5 CELL 1KARYOTYPE BANDING CDM","code_information":[{"code":"Px00030011578","type":"CDM"},{"code":"88261","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":505.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA CYTOMEGALOVIRUS QUANTIFICATION CDM","code_information":[{"code":"Px00030011582","type":"CDM"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":572.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SWEAT COLLECTION IONTOPHORESIS CDM","code_information":[{"code":"Px00030011583","type":"CDM"},{"code":"89230","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID CDM","code_information":[{"code":"Px00030011585","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS","code_information":[{"code":"Px00030011594","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DR-HLA FLOW","code_information":[{"code":"Px00030011598","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EIA ANTIGEN DETECTION","code_information":[{"code":"Px00030011608","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NASAL SMEAR EOSINOPHILS CDM","code_information":[{"code":"Px00030011609","type":"CDM"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NASAL SMEAR EOSINOPHILS CDM","code_information":[{"code":"Px00030011610","type":"CDM"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EPSTEIN BARR VIRUS BY PCR","code_information":[{"code":"Px00030011612","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":333.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA EPSTEIN BARR QUANTIFICATION EA ORG CDM","code_information":[{"code":"Px00030011613","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA ADDTL LAB","code_information":[{"code":"Px00030011621","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST LAB","code_information":[{"code":"Px00030011626","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ CDM","code_information":[{"code":"Px00030011637","type":"CDM"},{"code":"87510","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLYCO A FLOW","code_information":[{"code":"Px00030011640","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM","code_information":[{"code":"Px00030011646","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B SURFACE ANTIGEN CONFIRMATION","code_information":[{"code":"Px00030011648","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM","code_information":[{"code":"Px00030011653","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C RNA QUANTIFICATION","code_information":[{"code":"Px00030011655","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HIV VIRAL LOAD","code_information":[{"code":"Px00030011661","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030011673","type":"CDM"},{"code":"87532","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INF AGENT BY NUCLEIC ACID QUAN","code_information":[{"code":"Px00030011690","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT ANTIGEN DETECTION","code_information":[{"code":"Px00030011692","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT DETECTION AMPLIFIED PROBE","code_information":[{"code":"Px00030011693","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A CDM","code_information":[{"code":"Px00030011698","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA JC VIRUS AMP PROBE TQ EACH ORGANISM CDM","code_information":[{"code":"Px00030011700","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LAMBDA FLOW","code_information":[{"code":"Px00030011702","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MATURATION INDEX","code_information":[{"code":"Px00030011713","type":"CDM"},{"code":"88155","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC METABOLIC SCRN NEWBORN","code_information":[{"code":"Px00030011718","type":"CDM"},{"code":"S3620","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA CDM","code_information":[{"code":"Px00030011739","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PSA SCREENING  MEDICARE","code_information":[{"code":"Px00030011740","type":"CDM"},{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO STREPTOCOCCUS GROUP A LAB","code_information":[{"code":"Px00030011741","type":"CDM"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ELUTION RBC EACH ELUTION LAB","code_information":[{"code":"Px00030011742","type":"CDM"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS CDM","code_information":[{"code":"Px00030011749","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPECIAL STAIN GROUP 2  IRON","code_information":[{"code":"Px00030011751","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM CDM","code_information":[{"code":"Px00030011752","type":"CDM"},{"code":"89321","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SEMEN ANALYSIS  W/ HUHNER","code_information":[{"code":"Px00030011753","type":"CDM"},{"code":"89300","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SHIGATOXIN","code_information":[{"code":"Px00030011754","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT LAB","code_information":[{"code":"Px00030011759","type":"CDM"},{"code":"87653","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030011762","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY CDM","code_information":[{"code":"Px00030011861","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY TITER - ANCA TITER","code_information":[{"code":"Px00030011864","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":500.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIX E-PHORESIS SERUM - REF LAB","code_information":[{"code":"Px00030011867","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT","code_information":[{"code":"Px00030011868","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LYMPHOCYTE TR MITOGEN/AG INDUCED BLASTOGENESIS CDM","code_information":[{"code":"Px00030011871","type":"CDM"},{"code":"86353","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM","code_information":[{"code":"Px00030011916","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC KAPPA FLOW","code_information":[{"code":"Px00030011921","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SEMEN ALYS MOTILITY&CNT X W/HUHNER TST CDM","code_information":[{"code":"Px00030011929","type":"CDM"},{"code":"89310","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE LAB","code_information":[{"code":"Px00030011963","type":"CDM"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM","code_information":[{"code":"Px00030011966","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIA OTHER - GENITAL TRACT","code_information":[{"code":"Px00030011967","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CATHETERIZE FOR URINE SPECIMEN P9612","code_information":[{"code":"Px00030011972","type":"CDM"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FACTOR V LEIDEN PCR","code_information":[{"code":"Px00030011976","type":"CDM"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FACTOR II PROTHROMBIN GENE MUTAT","code_information":[{"code":"Px00030011977","type":"CDM"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PH  URINE QUALITATIVE","code_information":[{"code":"Px00030012009","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TRG GENE REARG TCELL IN TCELL","code_information":[{"code":"Px00030012012","type":"CDM"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRONE CDM","code_information":[{"code":"Px00030012037","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VOLTAGE-GATED K CHANNEL AB","code_information":[{"code":"Px00030012045","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INTERLEUKIN 6 BY MAFD","code_information":[{"code":"Px00030012050","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INTERLUKIN 10","code_information":[{"code":"Px00030012051","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ADENOSINE DEAMINASE CSF/FLUID","code_information":[{"code":"Px00030012065","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RBC MORPH","code_information":[{"code":"Px00030012072","type":"CDM"},{"code":"85008","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RETICULOCYTE COUNT-AUTO","code_information":[{"code":"Px00030012075","type":"CDM"},{"code":"85046","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T ADP SECRETION WBPAGG TECH","code_information":[{"code":"Px00030012091","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T COLLAGEN LOW AGG WBPAGG TECH","code_information":[{"code":"Px00030012096","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T COLLAGEN LOW SEC WBPAGG TECH","code_information":[{"code":"Px00030012097","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T RISTOCETIN HIGH AGG WBPAGG TEC","code_information":[{"code":"Px00030012098","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T RISTOCETIN LOW AGG WBPAGG TECH","code_information":[{"code":"Px00030012099","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T THROMBIN SECRETION WBPAGG TECH","code_information":[{"code":"Px00030012100","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRVVT (LUP INH)","code_information":[{"code":"Px00030012104","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TT PT/PS MIX","code_information":[{"code":"Px00030012106","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TT PT/CT MIX","code_information":[{"code":"Px00030012107","type":"CDM"},{"code":"85675","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PTT POST 60 MIN INCUBATION","code_information":[{"code":"Px00030012108","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGM","code_information":[{"code":"Px00030012117","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHROMATIN AUTOANTIBODIES","code_information":[{"code":"Px00030012120","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RNP AUTOANTIBODY","code_information":[{"code":"Px00030012123","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMRNP AUTOANTIBODY","code_information":[{"code":"Px00030012126","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SSA (RO) AUTOANTIBODY","code_information":[{"code":"Px00030012127","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HU  YO  RI ANTIBODIES","code_information":[{"code":"Px00030012130","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HU YO RI ABY TITER","code_information":[{"code":"Px00030012138","type":"CDM"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL SEROTYPE 1  IGG","code_information":[{"code":"Px00030012145","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD19 FLOW STANDALONE TEST","code_information":[{"code":"Px00030012159","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD3 FLOW STANDALONE TEST","code_information":[{"code":"Px00030012160","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD4 CD8/RATIO","code_information":[{"code":"Px00030012162","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BORRELIA","code_information":[{"code":"Px00030012199","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TECH INTERP-1-SPT","code_information":[{"code":"Px00030012202","type":"CDM"},{"code":"88164","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUICK STAIN ADDITIONAL TECH","code_information":[{"code":"Px00030012203","type":"CDM"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTOPLASMIC KAPPA-FLOW","code_information":[{"code":"Px00030012204","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTOPLASMIC LAMBDA-FLOW","code_information":[{"code":"Px00030012205","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T ADP AGGREGATION WBPAGG TECH","code_information":[{"code":"Px00030012208","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CAMPYLOBACTER CULTR","code_information":[{"code":"Px00030012225","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINOMYCES ANTIBODY","code_information":[{"code":"Px00030012386","type":"CDM"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MOLDX- CEBPA SEQUENCING","code_information":[{"code":"Px00030012402","type":"CDM"},{"code":"81218","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":387.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URINE PREGNANCY TEST","code_information":[{"code":"Px00030013001","type":"CDM"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPECIFIC GRAVITY EXCEPT URINE","code_information":[{"code":"Px00030013003","type":"CDM"},{"code":"84315","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CERULOPLASMIN CDM","code_information":[{"code":"Px00030013004","type":"CDM"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DEHYDROEPIANDROSTERONE","code_information":[{"code":"Px00030013005","type":"CDM"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":208.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MYOGLOBIN","code_information":[{"code":"Px00030013007","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC CDM","code_information":[{"code":"Px00030013008","type":"CDM"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM","code_information":[{"code":"Px00030013009","type":"CDM"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM","code_information":[{"code":"Px00030013010","type":"CDM"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE LAB","code_information":[{"code":"Px00030013012","type":"CDM"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF C-PEPTIDE","code_information":[{"code":"Px00030013013","type":"CDM"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CRYOGLOBULIN","code_information":[{"code":"Px00030013016","type":"CDM"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URINALYSIS VOLUME MEASURE","code_information":[{"code":"Px00030013017","type":"CDM"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ADRENOCORTICOTROPIC HORMONE ACTH CDM","code_information":[{"code":"Px00030013018","type":"CDM"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":277.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOLASE CDM","code_information":[{"code":"Px00030013019","type":"CDM"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN","code_information":[{"code":"Px00030013021","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THIAMINE VITAMIN B 1","code_information":[{"code":"Px00030013022","type":"CDM"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T3 REVERSE","code_information":[{"code":"Px00030013024","type":"CDM"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY IGA/IGD/IGG/IGM EACH","code_information":[{"code":"Px00030013026","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FACTOR INHIBITOR TEST CDM","code_information":[{"code":"Px00030013028","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN","code_information":[{"code":"Px00030013034","type":"CDM"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":644.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ANDROSTENEDIONE","code_information":[{"code":"Px00030013035","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC 17 HYDROXYPREGNENOLONE","code_information":[{"code":"Px00030013037","type":"CDM"},{"code":"84143","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY CARBOXYHB QUANT CDM","code_information":[{"code":"Px00030013039","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GENERAL HEALTH PANEL","code_information":[{"code":"Px00030013040","type":"CDM"},{"code":"80050","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE CDM","code_information":[{"code":"Px00030013041","type":"CDM"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CRYOFIBRINOGEN","code_information":[{"code":"Px00030013042","type":"CDM"},{"code":"82585","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN ELECTROPHORESIS","code_information":[{"code":"Px00030013048","type":"CDM"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SELENIUM CDM","code_information":[{"code":"Px00030013049","type":"CDM"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLINESTERASE ASSAY","code_information":[{"code":"Px00030013050","type":"CDM"},{"code":"82013","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG ZONISAMIDE","code_information":[{"code":"Px00030013055","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ZINC","code_information":[{"code":"Px00030013057","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD CLOT FACTOR VIII TEST VWF","code_information":[{"code":"Px00030013059","type":"CDM"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHLORAMPHENICOL","code_information":[{"code":"Px00030013076","type":"CDM"},{"code":"82415","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CROSS-LINKED N-TELOPEPTIDES","code_information":[{"code":"Px00030013078","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":290.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN BLD BY NMR","code_information":[{"code":"Px00030013080","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROCALCITONIN (PCT) CDM","code_information":[{"code":"Px00030013086","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL OTHER SOURCE","code_information":[{"code":"Px00030013090","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CADMIUM","code_information":[{"code":"Px00030013094","type":"CDM"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN STABILITY SCREEN","code_information":[{"code":"Px00030013100","type":"CDM"},{"code":"83068","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":219.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PREGNENOLONE CDM","code_information":[{"code":"Px00030013109","type":"CDM"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IGF BINDING PROTEIN 3","code_information":[{"code":"Px00030013124","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MYELIN BASIC PROTEIN CEREBROSPINAL FLUID CDM","code_information":[{"code":"Px00030013127","type":"CDM"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE TOTAL","code_information":[{"code":"Px00030013134","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TROPONIN QUALITATIVE CDM","code_information":[{"code":"Px00030013136","type":"CDM"},{"code":"84512","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHENYLALANINE PKU BLOOD","code_information":[{"code":"Px00030013137","type":"CDM"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RUSSELL VIPER VENOM DILUTED","code_information":[{"code":"Px00030013139","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESTRONE TMS(ARUP)","code_information":[{"code":"Px00030013181","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLIADIN AB IGG","code_information":[{"code":"Px00030013189","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GROWTH HORMONE (ARUP)","code_information":[{"code":"Px00030013192","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC Z82542 (REF LAB)","code_information":[{"code":"Px00030013335","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":354.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ZCARNITINE (OF PANL)","code_information":[{"code":"Px00030013629","type":"CDM"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ZINC PROTO (ZPP) BLOOD","code_information":[{"code":"Px00030013693","type":"CDM"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MANGANESE CDM","code_information":[{"code":"Px00030013773","type":"CDM"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CALPROTECTIN FECAL CDM","code_information":[{"code":"Px00030013774","type":"CDM"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN FREE CDM","code_information":[{"code":"Px00030013780","type":"CDM"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN CDM","code_information":[{"code":"Px00030013783","type":"CDM"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ARTERIAL BLOOD GASES","code_information":[{"code":"Px00030013788","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPARIN ASSAY CDM","code_information":[{"code":"Px00030013803","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYPROGESTERONE 17-D CDM","code_information":[{"code":"Px00030013811","type":"CDM"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE CDM","code_information":[{"code":"Px00030013840","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM SERUM","code_information":[{"code":"Px00030013847","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FACTOR INHIBITOR TEST CDM","code_information":[{"code":"Px00030013878","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FECAL OSMOLALITY","code_information":[{"code":"Px00030013880","type":"CDM"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FERRITIN CDM","code_information":[{"code":"Px00030013881","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY CDM","code_information":[{"code":"Px00030013889","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL CDM","code_information":[{"code":"Px00030013890","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LIPASE CDM","code_information":[{"code":"Px00030013912","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MAG ABY","code_information":[{"code":"Px00030013913","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":200.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PANCREATIC ELASTASE FECAL","code_information":[{"code":"Px00030013940","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":200.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PORPHOBILINOGEN DEAMINASE RBC","code_information":[{"code":"Px00030013946","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTIME","code_information":[{"code":"Px00030013953","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS CDM","code_information":[{"code":"Px00030013969","type":"CDM"},{"code":"85046","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SODIUM","code_information":[{"code":"Px00030013978","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RECEPTOR ASSAY NON-ENDOCRINE SPECIFY RECEPTOR CDM","code_information":[{"code":"Px00030013979","type":"CDM"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC UROBILINOGEN URINE-QUAL","code_information":[{"code":"Px00030013992","type":"CDM"},{"code":"84578","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA CDM","code_information":[{"code":"Px00030014009","type":"CDM"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRVVT","code_information":[{"code":"Px00030014048","type":"CDM"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL CDM","code_information":[{"code":"Px00030014052","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":163.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE CDM","code_information":[{"code":"Px00030014053","type":"CDM"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE CDM","code_information":[{"code":"Px00030014072","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOL MODULATING AB ASSAY","code_information":[{"code":"Px00030014075","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLINE RECEPTOR ABY","code_information":[{"code":"Px00030014078","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACH RECEPTOR (MUSC) BINDING AB","code_information":[{"code":"Px00030014087","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACHR GANGLIONIC NEURONAL ANTIB","code_information":[{"code":"Px00030014093","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACTH STIMULATION PANEL ADRENAL INSUFFICIENCY CDM","code_information":[{"code":"Px00030014095","type":"CDM"},{"code":"80400","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPECTROPHOTOMETRY ADENOSINE DEAMINASE CDM","code_information":[{"code":"Px00030014105","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030014113","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALDOSTERONE BLD","code_information":[{"code":"Px00030014129","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALKALINE PHOS","code_information":[{"code":"Px00030014138","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY CDM","code_information":[{"code":"Px00030014147","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1 ANTITRYPSIN FECES","code_information":[{"code":"Px00030014150","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":163.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL CDM","code_information":[{"code":"Px00030014151","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":163.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALUMINUM CDM","code_information":[{"code":"Px00030014159","type":"CDM"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE CDM","code_information":[{"code":"Px00030014168","type":"CDM"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AMINO ACIDS PLASMA QUANT","code_information":[{"code":"Px00030014174","type":"CDM"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":497.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AMNIO ACIDS EA SPECIMEN","code_information":[{"code":"Px00030014180","type":"CDM"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AMYLASE URINE","code_information":[{"code":"Px00030014228","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC CDM","code_information":[{"code":"Px00030014232","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":228.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030014234","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN I-CONVERTING ENZYME CDM","code_information":[{"code":"Px00030014236","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN F FETAL QUALITATIVE LAB","code_information":[{"code":"Px00030014286","type":"CDM"},{"code":"83033","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ARSENIC QUANT URINE","code_information":[{"code":"Px00030014291","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CYCLOSPORINE CDM","code_information":[{"code":"Px00030014330","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY TRANSFERRIN","code_information":[{"code":"Px00030014358","type":"CDM"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BETA-2 MICROGLOBULIN CDM","code_information":[{"code":"Px00030014367","type":"CDM"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BILE ACIDS TOTAL CDM","code_information":[{"code":"Px00030014414","type":"CDM"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030014447","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","code_information":[{"code":"Px00030014449","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BUN","code_information":[{"code":"Px00030014459","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF C-PEPTIDE CDM","code_information":[{"code":"Px00030014462","type":"CDM"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","code_information":[{"code":"Px00030014479","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCITONIN CDM","code_information":[{"code":"Px00030014480","type":"CDM"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030014481","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030014482","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARBON DIOXIDE BICARBONATE CDM","code_information":[{"code":"Px00030014495","type":"CDM"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARNITINE FREE AND TOTAL","code_information":[{"code":"Px00030014497","type":"CDM"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CATECHOLAMINES FRACTIONATED CDM","code_information":[{"code":"Px00030014500","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CBC WITH DIFF AUTO","code_information":[{"code":"Px00030014514","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN CEA CDM","code_information":[{"code":"Px00030014520","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CENTROMERE B ANTIBODY","code_information":[{"code":"Px00030014526","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CERULOPLASMIN CDM","code_information":[{"code":"Px00030014527","type":"CDM"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE BLOOD","code_information":[{"code":"Px00030014542","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE URINE","code_information":[{"code":"Px00030014544","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030014558","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHROMIUM WHOLE BLOOD","code_information":[{"code":"Px00030014561","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CITRATE CDM","code_information":[{"code":"Px00030014564","type":"CDM"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CK TOTAL","code_information":[{"code":"Px00030014566","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CK-MB","code_information":[{"code":"Px00030014567","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLLAGEN ADRENALIN PFSCN","code_information":[{"code":"Px00030014584","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLLAGEN EPINEPHERINE PFSCN","code_information":[{"code":"Px00030014588","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLUMN CHROMOTOGRAPHY QUANT","code_information":[{"code":"Px00030014590","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF COPPER CDM","code_information":[{"code":"Px00030014603","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL","code_information":[{"code":"Px00030014605","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL - TOTAL","code_information":[{"code":"Px00030014607","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL FREE URINE 24 HR","code_information":[{"code":"Px00030014608","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE CLEARANCE-SERUM + URINE","code_information":[{"code":"Px00030014631","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE URINE (REF)","code_information":[{"code":"Px00030014636","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRYOFIBRINOGEN PLASMA","code_information":[{"code":"Px00030014641","type":"CDM"},{"code":"82585","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRYOGLOBULIN SERUM","code_information":[{"code":"Px00030014642","type":"CDM"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC C-TELOPEPTIDE","code_information":[{"code":"Px00030014646","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYCLOSPORINE HEART TRANSPLANT","code_information":[{"code":"Px00030014651","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYSTATIN C CDM","code_information":[{"code":"Px00030014653","type":"CDM"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DDIMER QUANT","code_information":[{"code":"Px00030014674","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DEHYDROEPIANDROSTERONE CDM","code_information":[{"code":"Px00030014683","type":"CDM"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DEHYDROEPIANDROSTERONE-SULFATE CDM","code_information":[{"code":"Px00030014685","type":"CDM"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":208.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DNA QUANTITY ONLY","code_information":[{"code":"Px00030014700","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00030014775","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE CDM","code_information":[{"code":"Px00030014776","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENDOMYSIAL AB IGA","code_information":[{"code":"Px00030014782","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ERYTHROPOIETIN CDM","code_information":[{"code":"Px00030014795","type":"CDM"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESTRADIOL","code_information":[{"code":"Px00030014796","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII VW FACTOR ANTIGEN CDM","code_information":[{"code":"Px00030014830","type":"CDM"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FACTOR 9 INHIBITOR QUANT","code_information":[{"code":"Px00030014831","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR II PROTHROMBIN SPECIFIC CDM","code_information":[{"code":"Px00030014832","type":"CDM"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR IX PTC/CHRISTMAS CDM","code_information":[{"code":"Px00030014833","type":"CDM"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR CDM","code_information":[{"code":"Px00030014834","type":"CDM"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR CDM","code_information":[{"code":"Px00030014848","type":"CDM"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":184.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR X STUART-PROWER CDM","code_information":[{"code":"Px00030014866","type":"CDM"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR XI PTA CDM","code_information":[{"code":"Px00030014867","type":"CDM"},{"code":"85270","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR XII HAGEMAN CDM","code_information":[{"code":"Px00030014868","type":"CDM"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR XIII FIBRN STABILIZ SCREEN SOLUB CDM","code_information":[{"code":"Px00030014869","type":"CDM"},{"code":"85291","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FAT/LIPIDS FECES QUANTITATIVE CDM","code_information":[{"code":"Px00030014876","type":"CDM"},{"code":"82710","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM","code_information":[{"code":"Px00030014877","type":"CDM"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN CDM","code_information":[{"code":"Px00030014881","type":"CDM"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":373.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FETAL/MATERNAL BLOOD SCREEN","code_information":[{"code":"Px00030014884","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TACROLIMUS CDM","code_information":[{"code":"Px00030014892","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FOLIC ACID SERUM CDM","code_information":[{"code":"Px00030014898","type":"CDM"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FOLIC ACID RBC CDM","code_information":[{"code":"Px00030014899","type":"CDM"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FONDAPARINUX LEVEL","code_information":[{"code":"Px00030014900","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FREE T3 & TOTAL T3","code_information":[{"code":"Px00030014931","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE CDM","code_information":[{"code":"Px00030014932","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FREE THYROXINE CDM","code_information":[{"code":"Px00030014933","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GLYCATED PROTEIN CDM","code_information":[{"code":"Px00030014936","type":"CDM"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM","code_information":[{"code":"Px00030014937","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM","code_information":[{"code":"Px00030014938","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE CDM","code_information":[{"code":"Px00030014945","type":"CDM"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GAMMA GT TOTAL","code_information":[{"code":"Px00030014949","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IGA IGD IGG IGM EACH","code_information":[{"code":"Px00030014950","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00030014951","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GASTRIN CDM","code_information":[{"code":"Px00030014962","type":"CDM"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE POST GLUCOSE DOSE","code_information":[{"code":"Px00030014980","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD","code_information":[{"code":"Px00030014981","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE QUALITATIVE URINE","code_information":[{"code":"Px00030014985","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP)","code_information":[{"code":"Px00030014986","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE SERUM","code_information":[{"code":"Px00030014987","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE SERUM EA ADDL/DAY","code_information":[{"code":"Px00030014988","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECIMENS","code_information":[{"code":"Px00030014990","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN GLYCOSYLATED A1C CDM","code_information":[{"code":"Px00030015020","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN CDM","code_information":[{"code":"Px00030015027","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GROWTH HORMONE HUMAN CDM","code_information":[{"code":"Px00030015029","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HPYLORI DRUG ADMINISTRATION CDM","code_information":[{"code":"Px00030015033","type":"CDM"},{"code":"83014","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANTITATIVE CDM","code_information":[{"code":"Px00030015036","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUALITATIVE CDM","code_information":[{"code":"Px00030015043","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL CDM","code_information":[{"code":"Px00030015059","type":"CDM"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE CDM","code_information":[{"code":"Px00030015065","type":"CDM"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT (HCT)","code_information":[{"code":"Px00030015067","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE CDM","code_information":[{"code":"Px00030015078","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN (HGB)","code_information":[{"code":"Px00030015080","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE LAB","code_information":[{"code":"Px00030015085","type":"CDM"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN CDM","code_information":[{"code":"Px00030015086","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPARIN ASSAY CDM","code_information":[{"code":"Px00030015096","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HGB ELECTROPHORESIS FRACTION A2","code_information":[{"code":"Px00030015148","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HGB F QUANTITATIVE","code_information":[{"code":"Px00030015149","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN PLASMA CDM","code_information":[{"code":"Px00030015152","type":"CDM"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HOMOVANILLIC ACID (HVA)","code_information":[{"code":"Px00030015183","type":"CDM"},{"code":"83150","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - ARSENIC","code_information":[{"code":"Px00030015188","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - LEAD","code_information":[{"code":"Px00030015190","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HVY MET BLD - MERCURY","code_information":[{"code":"Px00030015191","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HVY MET UR - ARSENIC","code_information":[{"code":"Px00030015192","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HVY MET UR - LEAD","code_information":[{"code":"Px00030015194","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HVY MET UR - MERCURY","code_information":[{"code":"Px00030015195","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SERUM-PROTEIN ELP SERUM","code_information":[{"code":"Px00030015206","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD CDM","code_information":[{"code":"Px00030015207","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IGE SERUM TOTAL","code_information":[{"code":"Px00030015213","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT IGF BP3 CDM","code_information":[{"code":"Px00030015217","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SOMATOMEDIN CDM","code_information":[{"code":"Px00030015218","type":"CDM"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES LAB","code_information":[{"code":"Px00030015229","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY NONINFECT AG QUANT","code_information":[{"code":"Px00030015245","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES LAB","code_information":[{"code":"Px00030015258","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INSULIN LEVEL ASSAY","code_information":[{"code":"Px00030015267","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IRON","code_information":[{"code":"Px00030015298","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IRON BINDING CAPACITY CDM","code_information":[{"code":"Px00030015300","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC KAPPA QT FR LT CHAINS","code_information":[{"code":"Px00030015342","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC KETONE URINE QUALITATIVE","code_information":[{"code":"Px00030015349","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HGB/RBCS FETAL FETOMATERNAL HEMRRG DIFRNTL LYSIS CDM","code_information":[{"code":"Px00030015351","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LACTASE","code_information":[{"code":"Px00030015356","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE","code_information":[{"code":"Px00030015357","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LACTOFERRIN FECAL QUALITATIVE","code_information":[{"code":"Px00030015358","type":"CDM"},{"code":"83630","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LAMBDA FREE LIGHT CHAIN","code_information":[{"code":"Px00030015362","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LAMBDA QT FR LT CHAINS","code_information":[{"code":"Px00030015364","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LACTATE DEHYDROGENASE ISOENZYMES SEP&QUAN CDM","code_information":[{"code":"Px00030015370","type":"CDM"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LACTATE DEHYDROGENASE LDH CDM","code_information":[{"code":"Px00030015371","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LDH SERUM","code_information":[{"code":"Px00030015373","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL CDM","code_information":[{"code":"Px00030015375","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LEAD BLOOD","code_information":[{"code":"Px00030015376","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE CDM","code_information":[{"code":"Px00030015391","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN LUTEINIZING HORMONE CDM","code_information":[{"code":"Px00030015392","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LIDOCAINE CDM","code_information":[{"code":"Px00030015393","type":"CDM"},{"code":"80176","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIOW CYCLOSPORINE","code_information":[{"code":"Px00030015394","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN (A) CDM","code_information":[{"code":"Px00030015399","type":"CDM"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MAGNESIUM QUANT URINE","code_information":[{"code":"Px00030015421","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MAGNESIUM RBC","code_information":[{"code":"Px00030015422","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MALTASE","code_information":[{"code":"Px00030015426","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES CDM","code_information":[{"code":"Px00030015447","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES CDM","code_information":[{"code":"Px00030015448","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES URINE FRACT","code_information":[{"code":"Px00030015450","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACID 1 QUANTITATIVE CDM","code_information":[{"code":"Px00030015460","type":"CDM"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030015466","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT MODIFIED ELISA IGG CDM","code_information":[{"code":"Px00030015472","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MYOGLOBIN CDM","code_information":[{"code":"Px00030015558","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NEPHELOMETRY EACH ANALYTE NOT ELSEWHERE SPECIFIED","code_information":[{"code":"Px00030015571","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NI METABOLIC SCREEN CDM","code_information":[{"code":"Px00030015575","type":"CDM"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NMR-LIPOPROTEIN PAR QNT & SUBCLASSES","code_information":[{"code":"Px00030015580","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC N-TYPE CALCIUM CHANNEL AB","code_information":[{"code":"Px00030015590","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES CDM","code_information":[{"code":"Px00030015613","type":"CDM"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACIDS QUALITATIVE EACH SPECIMEN CDM","code_information":[{"code":"Px00030015629","type":"CDM"},{"code":"83919","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":644.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OSMOLALITY STOOL CLINICAL CHEM TEST","code_information":[{"code":"Px00030015630","type":"CDM"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OXALATE QUANT URINE","code_information":[{"code":"Px00030015633","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC P/Q TYPE CALCIUM CHANNEL ANTIB","code_information":[{"code":"Px00030015640","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PALATINASE","code_information":[{"code":"Px00030015642","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHENCYCLIDINE CDM","code_information":[{"code":"Px00030015662","type":"CDM"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PH GASTRIC CDM","code_information":[{"code":"Px00030015674","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHOSPHORUS QUANT URINE","code_information":[{"code":"Px00030015691","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FBRNLYC FACTORS&INHIBITRS PLSMNG XCPT AGIC ASS CDM","code_information":[{"code":"Px00030015693","type":"CDM"},{"code":"85420","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELET AGGREGATION EACH AGENT","code_information":[{"code":"Px00030015695","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUC BLD GLUC MNTR DEV","code_information":[{"code":"Px00030015715","type":"CDM"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF UREA NITROGEN QUANTITATIVE CDM","code_information":[{"code":"Px00030015716","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE BLOOD","code_information":[{"code":"Px00030015717","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT","code_information":[{"code":"Px00030015718","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE CDM","code_information":[{"code":"Px00030015719","type":"CDM"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030015761","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM CDM","code_information":[{"code":"Px00030015763","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD CDM","code_information":[{"code":"Px00030015764","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN S AG TOTAL","code_information":[{"code":"Px00030015778","type":"CDM"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD CDM","code_information":[{"code":"Px00030015782","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL URINE PAMC","code_information":[{"code":"Px00030015783","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN URINE RANDOM","code_information":[{"code":"Px00030015788","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEINASE-3 ANTIBODY EIA","code_information":[{"code":"Px00030015793","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PSA FREE","code_information":[{"code":"Px00030015809","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030015810","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY CDM","code_information":[{"code":"Px00030015823","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":56.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PYRUVATE CDM","code_information":[{"code":"Px00030015836","type":"CDM"},{"code":"84210","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANT BHCG","code_information":[{"code":"Px00030015837","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC CDM","code_information":[{"code":"Px00030015872","type":"CDM"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF RENIN CDM","code_information":[{"code":"Px00030015879","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEROTONIN","code_information":[{"code":"Px00030015924","type":"CDM"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SEX HORMONE BINDING GLOBU","code_information":[{"code":"Px00030015927","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"Px00030015928","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SGPT (ALT)","code_information":[{"code":"Px00030015931","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPECIFIC GRAVITY EXCEPT URINE CDM","code_information":[{"code":"Px00030015963","type":"CDM"},{"code":"84315","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PH STOOL CDM","code_information":[{"code":"Px00030015971","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUCRASE","code_information":[{"code":"Px00030015976","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OSMOLALITY URINE CDM","code_information":[{"code":"Px00030015987","type":"CDM"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE OTHER SOURCE CDM","code_information":[{"code":"Px00030015995","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 CDM","code_information":[{"code":"Px00030015997","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T3 UPTAKE","code_information":[{"code":"Px00030016000","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TACROLIMUS CDM","code_information":[{"code":"Px00030016004","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL CDM","code_information":[{"code":"Px00030016009","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE FREE","code_information":[{"code":"Px00030016011","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THIOCYANATE.","code_information":[{"code":"Px00030016025","type":"CDM"},{"code":"84430","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBIN III ACTIVITY","code_information":[{"code":"Px00030016030","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY LAB","code_information":[{"code":"Px00030016031","type":"CDM"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN LEVEL","code_information":[{"code":"Px00030016037","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROID STIMULATING IMMUNE GLOBULINS TSI CDM","code_information":[{"code":"Px00030016040","type":"CDM"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROXINE T4","code_information":[{"code":"Px00030016044","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"Px00030016086","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TROPONIN QUANTITATIVE","code_information":[{"code":"Px00030016091","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE TRYPTASE CDM","code_information":[{"code":"Px00030016097","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC UREA QUANT URINE","code_information":[{"code":"Px00030016112","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC UREA DIALYSATE","code_information":[{"code":"Px00030016113","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PORPHYRINS URINE QUANTITATION & FRACTIONATION CDM","code_information":[{"code":"Px00030016152","type":"CDM"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC USC THYROGLUBLIN LEVEL","code_information":[{"code":"Px00030016153","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THIAMINE-VITAMIN B-1 CDM","code_information":[{"code":"Px00030016184","type":"CDM"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PYRIDOXAL PHOSPHATE CDM","code_information":[{"code":"Px00030016188","type":"CDM"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED CDM","code_information":[{"code":"Px00030016189","type":"CDM"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VITAMIN-B12","code_information":[{"code":"Px00030016196","type":"CDM"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT CDM","code_information":[{"code":"Px00030016213","type":"CDM"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY CDM","code_information":[{"code":"Px00030016220","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ZINC CDM","code_information":[{"code":"Px00030016230","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA CDM","code_information":[{"code":"Px00030016242","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC STAPH AUREUS METHICILLIN RESISTANT AMPLIFIED PROBE","code_information":[{"code":"Px00030016253","type":"CDM"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE","code_information":[{"code":"Px00030016255","type":"CDM"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VW PROFILE-FACTOR ACTIVITY","code_information":[{"code":"Px00030016261","type":"CDM"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":238.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH ONLY CDM","code_information":[{"code":"Px00030016274","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE URINE","code_information":[{"code":"Px00030016275","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM CDM","code_information":[{"code":"Px00030016280","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS CDM","code_information":[{"code":"Px00030016284","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE PANEL EACH ALLERGEN","code_information":[{"code":"Px00030016288","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC KAPPA QUANT FREE LT CHAIN","code_information":[{"code":"Px00030016304","type":"CDM"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLLECTION VENOUS BLOOD VENIPUNCTURE CDM","code_information":[{"code":"Px00030016328","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LYSOZYME","code_information":[{"code":"Px00030016329","type":"CDM"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CITRATE ELP","code_information":[{"code":"Px00030016335","type":"CDM"},{"code":"82664","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030016339","type":"CDM"},{"code":"87653","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GC (AMP DNA PROBE)","code_information":[{"code":"Px00030017027","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPID PROFILE","code_information":[{"code":"Px00030017031","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBEOLA CDM","code_information":[{"code":"Px00030017035","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE CDM","code_information":[{"code":"Px00030017049","type":"CDM"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HLA I TYPING  LOW RESOLUTION  ONE ANTIGEN","code_information":[{"code":"Px00030017051","type":"CDM"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE WHOLE BLOOD","code_information":[{"code":"Px00030017053","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 LAB","code_information":[{"code":"Px00030050116","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA LAB","code_information":[{"code":"Px00030100010","type":"CDM"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY ACETAMINOPHEN LAB","code_information":[{"code":"Px00030100039","type":"CDM"},{"code":"80143","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY SALICYLATE LAB","code_information":[{"code":"Px00030100043","type":"CDM"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY LEFLUNOMIDE LAB","code_information":[{"code":"Px00030100046","type":"CDM"},{"code":"80193","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY METHOTREXATE LAB","code_information":[{"code":"Px00030100047","type":"CDM"},{"code":"80204","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALCOHOL (ETHANOL) SPEC XCP UR&BREATH IA LAB","code_information":[{"code":"Px00030100049","type":"CDM"},{"code":"82077","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100053","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VANILLYLMANDELIC ACID URINE LAB","code_information":[{"code":"Px00030100054","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100085","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HOMOVANILLIC ACID LAB","code_information":[{"code":"Px00030100086","type":"CDM"},{"code":"83150","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY METHOTREXATE LAB","code_information":[{"code":"Px00030100110","type":"CDM"},{"code":"80204","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALKALOIDS NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030100117","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030100121","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB","code_information":[{"code":"Px00030100123","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB","code_information":[{"code":"Px00030100124","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100126","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM","code_information":[{"code":"Px00030100127","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRIOL","code_information":[{"code":"Px00030100128","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE","code_information":[{"code":"Px00030100129","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN I-CONVERTING ENZYME LAB","code_information":[{"code":"Px00030100132","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100134","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100135","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB","code_information":[{"code":"Px00030100137","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES LAB","code_information":[{"code":"Px00030100140","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 13 OR MORE LAB","code_information":[{"code":"Px00030100158","type":"CDM"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 LAB","code_information":[{"code":"Px00030100159","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS LAB","code_information":[{"code":"Px00030100165","type":"CDM"},{"code":"81329","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS CDM","code_information":[{"code":"Px00030100178","type":"CDM"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030100186","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB","code_information":[{"code":"Px00030100196","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE OTHER SOURCE LAB","code_information":[{"code":"Px00030100198","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB","code_information":[{"code":"Px00030100200","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE OTHER SOURCE LAB","code_information":[{"code":"Px00030100201","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEMAN LAB","code_information":[{"code":"Px00030100202","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY","code_information":[{"code":"Px00030100203","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN UNSTABLE SCREEN LAB","code_information":[{"code":"Px00030100204","type":"CDM"},{"code":"83068","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":219.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY LAB","code_information":[{"code":"Px00030100208","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100215","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1176.0,"discounted_cash":823.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100238","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HISTAMINE LAB","code_information":[{"code":"Px00030100239","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL LAB","code_information":[{"code":"Px00030100246","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":163.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE LAB","code_information":[{"code":"Px00030100260","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 LAB","code_information":[{"code":"Px00030100315","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ELASTASE PANCREATIC FECAL QUANTITATIVE LAB","code_information":[{"code":"Px00030100376","type":"CDM"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":200.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100377","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100382","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030100392","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100396","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100397","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100408","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH LAB","code_information":[{"code":"Px00030100409","type":"CDM"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100414","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"Px00030100415","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100428","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100454","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM LAB","code_information":[{"code":"Px00030100455","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM SERUM PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030100483","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SODIUM SERUM PLASMA OR WHOLE BLOOD LAB","code_information":[{"code":"Px00030100484","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID LAB","code_information":[{"code":"Px00030100485","type":"CDM"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100486","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY LAB","code_information":[{"code":"Px00030100487","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE","code_information":[{"code":"Px00030100489","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OXYCODONE LAB","code_information":[{"code":"Px00030100513","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 LAB","code_information":[{"code":"Px00030100523","type":"CDM"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030100524","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100541","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100542","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TACROLIMUS LAB","code_information":[{"code":"Px00030100543","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE VANCOMYCIN LAB","code_information":[{"code":"Px00030100544","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100550","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100551","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100552","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE","code_information":[{"code":"Px00030100553","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100554","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030100555","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE LAB","code_information":[{"code":"Px00030100561","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030100562","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100563","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URINE ALBUMIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100564","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM LAB","code_information":[{"code":"Px00030100566","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE LAB","code_information":[{"code":"Px00030100567","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE","code_information":[{"code":"Px00030100568","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE LAB","code_information":[{"code":"Px00030100569","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100570","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100571","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN DIRECT LAB","code_information":[{"code":"Px00030100572","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030100574","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100576","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM LAB","code_information":[{"code":"Px00030100577","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100579","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100580","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100581","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030100582","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100583","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100584","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATINE KINASE TOTAL LAB","code_information":[{"code":"Px00030100585","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATINE KINASE MB FRACTION ONLY LAB","code_information":[{"code":"Px00030100587","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100588","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100592","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100593","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100594","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030100595","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRADIOL LAB","code_information":[{"code":"Px00030100596","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100603","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100604","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100605","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100606","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH LAB","code_information":[{"code":"Px00030100607","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE","code_information":[{"code":"Px00030100609","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030100610","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE POST GLUCOSE DOSE LAB","code_information":[{"code":"Px00030100616","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE","code_information":[{"code":"Px00030100617","type":"CDM"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HPYLORI DRUG ADMINISTRATION","code_information":[{"code":"Px00030100618","type":"CDM"},{"code":"83014","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN TOTAL LAB","code_information":[{"code":"Px00030100622","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN FREE LAB","code_information":[{"code":"Px00030100623","type":"CDM"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100624","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100625","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LIPASE LAB","code_information":[{"code":"Px00030100626","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN BLOOD QUAN NUMBERS & SUBCLASSES LAB","code_information":[{"code":"Px00030100627","type":"CDM"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL LAB","code_information":[{"code":"Px00030100628","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100630","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030100631","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030100632","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE LAB","code_information":[{"code":"Px00030100634","type":"CDM"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM URINE LAB","code_information":[{"code":"Px00030100635","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100636","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100637","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD LAB","code_information":[{"code":"Px00030100638","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100639","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100640","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM LAB","code_information":[{"code":"Px00030100644","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM LAB","code_information":[{"code":"Px00030100645","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI LAB","code_information":[{"code":"Px00030100647","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTOPORPHYRIN RBC QUANTITATIVE LAB","code_information":[{"code":"Px00030100649","type":"CDM"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROINSULIN LAB","code_information":[{"code":"Px00030100650","type":"CDM"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN LAB","code_information":[{"code":"Px00030100651","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030100652","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE LAB","code_information":[{"code":"Px00030100653","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE LAB","code_information":[{"code":"Px00030100654","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100655","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100656","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE TOTAL LAB","code_information":[{"code":"Px00030100657","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROXINE TOTAL LAB","code_information":[{"code":"Px00030100658","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FREE THYROXINE LAB","code_information":[{"code":"Px00030100659","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100661","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB","code_information":[{"code":"Px00030100662","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROID HORM UPTK/THYROID HORMONE BINDING RATIO LAB","code_information":[{"code":"Px00030100663","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROID HORM UPTK/THYROID HORMONE BINDING RATIO LAB","code_information":[{"code":"Px00030100664","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB","code_information":[{"code":"Px00030100665","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TROPONIN QUANTITATIVE LAB","code_information":[{"code":"Px00030100666","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB","code_information":[{"code":"Px00030100667","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID LAB","code_information":[{"code":"Px00030100668","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY INFLIXIMAB LAB","code_information":[{"code":"Px00030100760","type":"CDM"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE URINE LAB","code_information":[{"code":"Px00030100761","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATINE KINASE MB FRACTION ONLY LAB","code_information":[{"code":"Px00030100762","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030100763","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL","code_information":[{"code":"Px00030100764","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE BODY FLUID OTHER THAN BLOOD LAB","code_information":[{"code":"Px00030100765","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD LAB","code_information":[{"code":"Px00030100766","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB","code_information":[{"code":"Px00030100770","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRIGLYCERIDES LAB","code_information":[{"code":"Px00030100771","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ZINC LAB","code_information":[{"code":"Px00030100772","type":"CDM"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL LAB","code_information":[{"code":"Px00030100775","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN FREE LAB","code_information":[{"code":"Px00030100776","type":"CDM"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030100777","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROGLOBULIN LAB","code_information":[{"code":"Px00030100780","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030100812","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030100813","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL LAB","code_information":[{"code":"Px00030100818","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE LAB","code_information":[{"code":"Px00030100838","type":"CDM"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100855","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL LAB","code_information":[{"code":"Px00030100856","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100857","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100858","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100859","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030100860","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHENCYCLIDINE LAB","code_information":[{"code":"Px00030100861","type":"CDM"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030100862","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE","code_information":[{"code":"Px00030100958","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROCALCITONIN (PCT) LAB","code_information":[{"code":"Px00030100967","type":"CDM"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED LAB","code_information":[{"code":"Px00030101031","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM URINE LAB","code_information":[{"code":"Px00030101041","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE SODIUM LAB","code_information":[{"code":"Px00030101044","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE URINE LAB","code_information":[{"code":"Px00030101045","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB","code_information":[{"code":"Px00030101046","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB","code_information":[{"code":"Px00030101047","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FOLIC ACID RBC LAB","code_information":[{"code":"Px00030101050","type":"CDM"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030101052","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101056","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101057","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101058","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101059","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101060","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101062","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030101063","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030101066","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID","code_information":[{"code":"Px00030101069","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030101072","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00030101073","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101085","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTATE LAB","code_information":[{"code":"Px00030101086","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN LAB","code_information":[{"code":"Px00030101279","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030101284","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030101322","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI LAB","code_information":[{"code":"Px00030101361","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CA 19.9","code_information":[{"code":"Px00030110009","type":"CDM"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM","code_information":[{"code":"Px00030110064","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL LAB","code_information":[{"code":"Px00030110073","type":"CDM"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF BLOOD/URIC ACID CDM","code_information":[{"code":"Px00030110077","type":"CDM"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030110082","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI LAB","code_information":[{"code":"Px00030110084","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC LAB","code_information":[{"code":"Px00030110085","type":"CDM"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL OF NMR","code_information":[{"code":"Px00030110101","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMETRY","code_information":[{"code":"Px00030110102","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES W/O2 SATURATION CDM","code_information":[{"code":"Px00030110103","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD O2 SATURATION ONLY DIRECT MEAS","code_information":[{"code":"Px00030110104","type":"CDM"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD GAS","code_information":[{"code":"Px00030110105","type":"CDM"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD O2 SATURATION ONLY DIRECT MEAS","code_information":[{"code":"Px00030110106","type":"CDM"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD O2 SATURATION ONLY DIRECT MEAS","code_information":[{"code":"Px00030110107","type":"CDM"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT CAFFEINE LAB","code_information":[{"code":"Px00030110127","type":"CDM"},{"code":"80155","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT CLOZAPINE LAB","code_information":[{"code":"Px00030110128","type":"CDM"},{"code":"80159","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT EVEROLIMUS LAB","code_information":[{"code":"Px00030110129","type":"CDM"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE GABAPENTIN LAB","code_information":[{"code":"Px00030110130","type":"CDM"},{"code":"80171","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LAMOTRIGINE LAB","code_information":[{"code":"Px00030110131","type":"CDM"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCRN QUAN LEVETIRACETAM","code_information":[{"code":"Px00030110132","type":"CDM"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":104.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE MYCOPHENOLATE LAB","code_information":[{"code":"Px00030110133","type":"CDM"},{"code":"80180","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCRN QUANT OXCARBAZEPIN LAB","code_information":[{"code":"Px00030110134","type":"CDM"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT TIAGABINE","code_information":[{"code":"Px00030110135","type":"CDM"},{"code":"80199","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ZONISAMIDE LAB","code_information":[{"code":"Px00030110136","type":"CDM"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES","code_information":[{"code":"Px00030110156","type":"CDM"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR PER DOS","code_information":[{"code":"Px00030110158","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROGLOBULIN LAB","code_information":[{"code":"Px00030110165","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE AMIKACIN LAB","code_information":[{"code":"Px00030110166","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE AMIKACIN LAB","code_information":[{"code":"Px00030110167","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE AMIKACIN LAB","code_information":[{"code":"Px00030110168","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LACTOFERRIN FECAL QUANTITATIVE LAB","code_information":[{"code":"Px00030110181","type":"CDM"},{"code":"83631","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL LAB","code_information":[{"code":"Px00030110185","type":"CDM"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PARATHORMONE LAB","code_information":[{"code":"Px00030110189","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE","code_information":[{"code":"Px00030110193","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE","code_information":[{"code":"Px00030110194","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030110211","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":163.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR CDM","code_information":[{"code":"Px00030110219","type":"CDM"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY ADALIMUMAB LAB","code_information":[{"code":"Px00030110238","type":"CDM"},{"code":"80145","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY INFLIXIMAB","code_information":[{"code":"Px00030110240","type":"CDM"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY LACOSAMIDE LAB","code_information":[{"code":"Px00030110241","type":"CDM"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL LAB","code_information":[{"code":"Px00030110250","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE","code_information":[{"code":"Px00030110253","type":"CDM"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB","code_information":[{"code":"Px00030110257","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CC MSC CYSTIC FIBROSIS COMMON MUTATION SCRN","code_information":[{"code":"Px00030110274","type":"CDM"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":543.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM LAB","code_information":[{"code":"Px00030110305","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL LAB","code_information":[{"code":"Px00030110444","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2","code_information":[{"code":"Px00030110459","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URINE ALBUMIN QUANTITATIVE LAB","code_information":[{"code":"Px00030110479","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030110480","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENOBARBITAL CDM","code_information":[{"code":"Px00030110510","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OXALATE LAB","code_information":[{"code":"Px00030110532","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM URINE QUANTITATIVE TIMED SPECIMEN LAB","code_information":[{"code":"Px00030110534","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTROGEN SERUM","code_information":[{"code":"Px00030110536","type":"CDM"},{"code":"82672","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE BLOOD REAGENT STRIP","code_information":[{"code":"Px00030110569","type":"CDM"},{"code":"82948","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOSTERONE PLASMA LAB","code_information":[{"code":"Px00030110584","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA FETOPROTEIN TUMOR MARKER","code_information":[{"code":"Px00030110587","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE LAB","code_information":[{"code":"Px00030110600","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VANCOMYCIN","code_information":[{"code":"Px00030110602","type":"CDM"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB","code_information":[{"code":"Px00030110603","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE LAB","code_information":[{"code":"Px00030110605","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC UROBILINOGEN URINE QUANTITATIVE TIMED SPECIMEN","code_information":[{"code":"Px00030110617","type":"CDM"},{"code":"84580","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS CDM","code_information":[{"code":"Px00030110635","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 LAB","code_information":[{"code":"Px00030110636","type":"CDM"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALKALOIDS NOS","code_information":[{"code":"Px00030110638","type":"CDM"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN AMPHETAMINES 1 OR 2","code_information":[{"code":"Px00030110639","type":"CDM"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AMPHETAMINES 3OR 4","code_information":[{"code":"Px00030110640","type":"CDM"},{"code":"80325","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AMPHETAMINES 5 OR MORE","code_information":[{"code":"Px00030110641","type":"CDM"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANALGESICS NON-OPIOID 1 OR 2","code_information":[{"code":"Px00030110644","type":"CDM"},{"code":"80329","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANTS CLASS 1 OR 2","code_information":[{"code":"Px00030110647","type":"CDM"},{"code":"80332","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANTS CLASS 3-5","code_information":[{"code":"Px00030110648","type":"CDM"},{"code":"80333","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 6/MORE CDM","code_information":[{"code":"Px00030110652","type":"CDM"},{"code":"80337","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED CDM","code_information":[{"code":"Px00030110653","type":"CDM"},{"code":"80338","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIEPILEPTICS NOS 1-3","code_information":[{"code":"Px00030110654","type":"CDM"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3","code_information":[{"code":"Px00030110657","type":"CDM"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIPSYCHOTICS NOS 4-6","code_information":[{"code":"Px00030110658","type":"CDM"},{"code":"80343","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BARBITURATES CDM","code_information":[{"code":"Px00030110660","type":"CDM"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BENZODIAZEPINES 13 OR MORE","code_information":[{"code":"Px00030110662","type":"CDM"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":120.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING BUPRENORPHINE LAB","code_information":[{"code":"Px00030110663","type":"CDM"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CANNABINOIDS NATURAL","code_information":[{"code":"Px00030110664","type":"CDM"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING COCAINE","code_information":[{"code":"Px00030110668","type":"CDM"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING FENTANYL CDM","code_information":[{"code":"Px00030110669","type":"CDM"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING HEROIN METABOLITE CDM","code_information":[{"code":"Px00030110671","type":"CDM"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING KETAMINE AND NORKETAMINE LAB","code_information":[{"code":"Px00030110672","type":"CDM"},{"code":"80357","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHADONE CDM","code_information":[{"code":"Px00030110673","type":"CDM"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES LAB","code_information":[{"code":"Px00030110674","type":"CDM"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC METHYLPHENIDATE","code_information":[{"code":"Px00030110675","type":"CDM"},{"code":"80360","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPIATES 1 OR MORE","code_information":[{"code":"Px00030110676","type":"CDM"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPIOIDS & OPIATE ANALOGS 1 OR 2","code_information":[{"code":"Px00030110677","type":"CDM"},{"code":"80362","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPIOID &OPIATE ANALOG 5/MORE","code_information":[{"code":"Px00030110679","type":"CDM"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING OXYCODONE","code_information":[{"code":"Px00030110680","type":"CDM"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING PROPOXYPHENE","code_information":[{"code":"Px00030110682","type":"CDM"},{"code":"80367","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SKELETAL MUSCLE RELAXANT 1 OR 2","code_information":[{"code":"Px00030110684","type":"CDM"},{"code":"80369","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREENING TRAMADOL LAB","code_information":[{"code":"Px00030110688","type":"CDM"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG/SUBSTANCE NOS 1-3","code_information":[{"code":"Px00030110690","type":"CDM"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7/MORE CDM","code_information":[{"code":"Px00030110692","type":"CDM"},{"code":"80377","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL FREE LAB","code_information":[{"code":"Px00030110741","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY LAB","code_information":[{"code":"Px00030110747","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACYLCARNITINES QUANTIATIVE EACH SPECIMEN LAB","code_information":[{"code":"Px00030110810","type":"CDM"},{"code":"82017","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 LAB","code_information":[{"code":"Px00030111010","type":"CDM"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE BLOOD REAGENT STRIP LAB","code_information":[{"code":"Px00030112001","type":"CDM"},{"code":"82948","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SERUM ALBUMIN","code_information":[{"code":"Px00030112003","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OCCULT BLOOD FECES","code_information":[{"code":"Px00030112004","type":"CDM"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LACTIC ACID","code_information":[{"code":"Px00030112005","type":"CDM"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATINE MB FRACTION","code_information":[{"code":"Px00030112006","type":"CDM"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TRANSFERRIN","code_information":[{"code":"Px00030112011","type":"CDM"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SOMATOMEDIN LAB","code_information":[{"code":"Px00030112012","type":"CDM"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HAPTOGLOBIN QUANT","code_information":[{"code":"Px00030112013","type":"CDM"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM","code_information":[{"code":"Px00030112014","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF BLOOD CHLORIDE","code_information":[{"code":"Px00030112015","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SODIUM BLOOD","code_information":[{"code":"Px00030112016","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL LAB","code_information":[{"code":"Px00030112018","type":"CDM"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TACROLIMUS","code_information":[{"code":"Px00030112019","type":"CDM"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MICROALBUMIN QUANTITATIVE","code_information":[{"code":"Px00030112020","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL LAB","code_information":[{"code":"Px00030112022","type":"CDM"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":163.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL","code_information":[{"code":"Px00030112023","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE","code_information":[{"code":"Px00030112024","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TEST FOR ACETONE/KETONES","code_information":[{"code":"Px00030112025","type":"CDM"},{"code":"82009","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM IONIZED","code_information":[{"code":"Px00030112027","type":"CDM"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS ACUTE PANEL","code_information":[{"code":"Px00030112029","type":"CDM"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHORIONIC GONADOTROPIN QUAL","code_information":[{"code":"Px00030112030","type":"CDM"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ELECTROLYTE PANEL","code_information":[{"code":"Px00030112031","type":"CDM"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALPHA-FETOPROTEIN SERUM CDM","code_information":[{"code":"Px00030112032","type":"CDM"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD METHEMOGLOBIN ASSAY","code_information":[{"code":"Px00030112033","type":"CDM"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FETAL FIBRONECTIN","code_information":[{"code":"Px00030112034","type":"CDM"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":373.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URINE VMA","code_information":[{"code":"Px00030112036","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD","code_information":[{"code":"Px00030112037","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN A LAB","code_information":[{"code":"Px00030112039","type":"CDM"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CREATININE","code_information":[{"code":"Px00030112042","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN DIRECT","code_information":[{"code":"Px00030112043","type":"CDM"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OSMOLALITY URINE","code_information":[{"code":"Px00030112044","type":"CDM"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PREALBUMIN CDM","code_information":[{"code":"Px00030112045","type":"CDM"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY CARBAMAZEPINE TOTAL CDM","code_information":[{"code":"Px00030112046","type":"CDM"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE CDM","code_information":[{"code":"Px00030112048","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CALCITONIN","code_information":[{"code":"Px00030112049","type":"CDM"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENOBARBITAL LAB","code_information":[{"code":"Px00030112050","type":"CDM"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RENIN","code_information":[{"code":"Px00030112051","type":"CDM"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CAROTENE","code_information":[{"code":"Px00030112052","type":"CDM"},{"code":"82380","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VOLATILES","code_information":[{"code":"Px00030112053","type":"CDM"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL FREE CDM","code_information":[{"code":"Px00030112054","type":"CDM"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM URINE","code_information":[{"code":"Px00030112055","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN LAB","code_information":[{"code":"Px00030112056","type":"CDM"},{"code":"82960","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL TOTAL LAB","code_information":[{"code":"Px00030112057","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OSMOLALITY BLOOD","code_information":[{"code":"Px00030112058","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM TOTAL LAB","code_information":[{"code":"Px00030112060","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BASIC METABOLIC PANEL","code_information":[{"code":"Px00030112061","type":"CDM"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPREHEN METABOLIC PANEL","code_information":[{"code":"Px00030112062","type":"CDM"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LIPID PANEL","code_information":[{"code":"Px00030112063","type":"CDM"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RENAL FUNCTION PANEL CDM","code_information":[{"code":"Px00030112064","type":"CDM"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROXINE FREE","code_information":[{"code":"Px00030112065","type":"CDM"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROGESTERONE CDM","code_information":[{"code":"Px00030112067","type":"CDM"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GTT-ADDED SAMPLES","code_information":[{"code":"Px00030112068","type":"CDM"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRADIOL","code_information":[{"code":"Px00030112069","type":"CDM"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE THEOPHYLLINE CDM","code_information":[{"code":"Px00030112071","type":"CDM"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHOSPHORUS URINE","code_information":[{"code":"Px00030112072","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROLACTIN CDM","code_information":[{"code":"Px00030112073","type":"CDM"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FOLIC ACID RBC","code_information":[{"code":"Px00030112074","type":"CDM"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OBSTETRIC PANEL LAB","code_information":[{"code":"Px00030112076","type":"CDM"},{"code":"80055","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OXALATE CDM","code_information":[{"code":"Px00030112077","type":"CDM"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG GABAPENTINE","code_information":[{"code":"Px00030112078","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VIT D 1 25-DIHYDROXY","code_information":[{"code":"Px00030112079","type":"CDM"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY GROWTH HORMONE (HGH)","code_information":[{"code":"Px00030112080","type":"CDM"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ACID PROSTATIC LAB","code_information":[{"code":"Px00030112081","type":"CDM"},{"code":"84066","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CYANIDE","code_information":[{"code":"Px00030112082","type":"CDM"},{"code":"82600","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE LAB","code_information":[{"code":"Px00030112083","type":"CDM"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PYRIDOXAL PHOSPHATE VITAMIN B 6","code_information":[{"code":"Px00030112084","type":"CDM"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ETHYLENE GLYCOL","code_information":[{"code":"Px00030112087","type":"CDM"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN FREE CDM","code_information":[{"code":"Px00030112088","type":"CDM"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SEROTONIN","code_information":[{"code":"Px00030112089","type":"CDM"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LIPOPROTEIN(A) LAB","code_information":[{"code":"Px00030112090","type":"CDM"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PROCAINAMIDE METABOLITE LAB","code_information":[{"code":"Px00030112091","type":"CDM"},{"code":"80192","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROGESTERONE","code_information":[{"code":"Px00030112092","type":"CDM"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SIROLIMUS","code_information":[{"code":"Px00030112093","type":"CDM"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOPIRAMATE LAB","code_information":[{"code":"Px00030112094","type":"CDM"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE QUINIDINE CDM","code_information":[{"code":"Px00030112097","type":"CDM"},{"code":"80194","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF INSULIN TOTAL CDM","code_information":[{"code":"Px00030112100","type":"CDM"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LACTATE (LD) (LDH) ENZYME","code_information":[{"code":"Px00030112101","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY BLOOD CARBON DIOXIDE","code_information":[{"code":"Px00030112102","type":"CDM"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATIC FUNCTION PANEL CDM","code_information":[{"code":"Px00030112103","type":"CDM"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALANINE AMINO (ALT) (SGPT)","code_information":[{"code":"Px00030112104","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GGT","code_information":[{"code":"Px00030112105","type":"CDM"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD FOLIC ACID SERUM","code_information":[{"code":"Px00030112106","type":"CDM"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY PHOSPHORUS","code_information":[{"code":"Px00030112107","type":"CDM"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMMONIA LAB","code_information":[{"code":"Px00030112108","type":"CDM"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL CDM","code_information":[{"code":"Px00030112109","type":"CDM"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ERYTHROPOIETIN","code_information":[{"code":"Px00030112110","type":"CDM"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FERRITIN","code_information":[{"code":"Px00030112111","type":"CDM"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF IRON","code_information":[{"code":"Px00030112112","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FREE ASSAY (FT-3)","code_information":[{"code":"Px00030112114","type":"CDM"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE TOTAL","code_information":[{"code":"Px00030112115","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE LITHIUM CDM","code_information":[{"code":"Px00030112116","type":"CDM"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IRON BINDING CAPACITY LAB","code_information":[{"code":"Px00030112117","type":"CDM"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROXINE TOTAL","code_information":[{"code":"Px00030112118","type":"CDM"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LDH ENZYMES","code_information":[{"code":"Px00030112122","type":"CDM"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN","code_information":[{"code":"Px00030112123","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PRIMIDONE LAB","code_information":[{"code":"Px00030112124","type":"CDM"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROID (T3 OR T4)","code_information":[{"code":"Px00030112125","type":"CDM"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH ONLY","code_information":[{"code":"Px00030112126","type":"CDM"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY 17- KETOSTEROIDS","code_information":[{"code":"Px00030112127","type":"CDM"},{"code":"83586","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GASTRIN","code_information":[{"code":"Px00030112128","type":"CDM"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG LAMOTRIGINE","code_information":[{"code":"Px00030112130","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VASOACTIVE INTESTINAL PEPTIDE LAB","code_information":[{"code":"Px00030112134","type":"CDM"},{"code":"84586","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HEMOSIDERIN QUALITATIVE LAB","code_information":[{"code":"Px00030112135","type":"CDM"},{"code":"83070","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCULUS SPECTROSCOPY","code_information":[{"code":"Px00030112138","type":"CDM"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY CDM","code_information":[{"code":"Px00030112142","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROINSULIN","code_information":[{"code":"Px00030112143","type":"CDM"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUGARS SINGLE QUALITATIVE EACH SPECIMEN","code_information":[{"code":"Px00030112145","type":"CDM"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DHEA","code_information":[{"code":"Px00030112148","type":"CDM"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG KEPPRA","code_information":[{"code":"Px00030112150","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACTH STIMULATION PANEL","code_information":[{"code":"Px00030112151","type":"CDM"},{"code":"80400","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CORTICOSTEROIDS","code_information":[{"code":"Px00030112153","type":"CDM"},{"code":"83491","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":296.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN F FETAL QUALITATIVE LAB","code_information":[{"code":"Px00030112154","type":"CDM"},{"code":"83033","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TRYPTASE","code_information":[{"code":"Px00030112155","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHATASE ALKALINE LAB","code_information":[{"code":"Px00030112158","type":"CDM"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LIPASE","code_information":[{"code":"Px00030112159","type":"CDM"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PARATHORMONE (PARATHYROID HORMONE)","code_information":[{"code":"Px00030112161","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TRANSFERASE ASPARTATE AMINO AST SGOT","code_information":[{"code":"Px00030112162","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GENTAMICIN","code_information":[{"code":"Px00030112164","type":"CDM"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN FREE","code_information":[{"code":"Px00030112165","type":"CDM"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VITAMIN B-12","code_information":[{"code":"Px00030112166","type":"CDM"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CARNITINE","code_information":[{"code":"Px00030112171","type":"CDM"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SODIUM URINE","code_information":[{"code":"Px00030112172","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYCLOSPORINE","code_information":[{"code":"Px00030112173","type":"CDM"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL CDM","code_information":[{"code":"Px00030112174","type":"CDM"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TOCOPHEROL ALPHA VITAMIN E LAB","code_information":[{"code":"Px00030112175","type":"CDM"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OLIGOCLONAL IMMUNE","code_information":[{"code":"Px00030112178","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE ISOENZYME","code_information":[{"code":"Px00030112180","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF VITAMIN K LAB","code_information":[{"code":"Px00030112185","type":"CDM"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCULUS ASSAY QUANT","code_information":[{"code":"Px00030112188","type":"CDM"},{"code":"82360","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SODIUM OTHER SOURCE LAB","code_information":[{"code":"Px00030112190","type":"CDM"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY TRIIODOTHYRONINE (T3)","code_information":[{"code":"Px00030112193","type":"CDM"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030112195","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG AMIODARONE","code_information":[{"code":"Px00030112196","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTOPORPHYRIN RBC QUANTITATIVE CDM","code_information":[{"code":"Px00030112199","type":"CDM"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY DIPROPYLACETIC ACID DEPAKANE","code_information":[{"code":"Px00030112201","type":"CDM"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLLAGEN CROSSLINKS","code_information":[{"code":"Px00030112207","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":290.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG CLOZAPINE","code_information":[{"code":"Px00030112210","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRIOL","code_information":[{"code":"Px00030112211","type":"CDM"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHOSPHATASE ACID TOTAL","code_information":[{"code":"Px00030112212","type":"CDM"},{"code":"84060","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ASCORBIC ACID","code_information":[{"code":"Px00030112213","type":"CDM"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG METHOTREXATE LAB","code_information":[{"code":"Px00030112215","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"Px00030112216","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY CREATININE","code_information":[{"code":"Px00030112217","type":"CDM"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF BETA-2 PROTEIN","code_information":[{"code":"Px00030112218","type":"CDM"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTROGENS TOTAL LAB","code_information":[{"code":"Px00030112220","type":"CDM"},{"code":"82672","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHOSPHATASE ALKALINE ISOENZYMES","code_information":[{"code":"Px00030112222","type":"CDM"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG DIGITOXIN LAB","code_information":[{"code":"Px00030112223","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RECEPTOR ASSAY NON ENDOCRINE","code_information":[{"code":"Px00030112226","type":"CDM"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL CDM","code_information":[{"code":"Px00030112228","type":"CDM"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM","code_information":[{"code":"Px00030112229","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACID SINGLE QUANTITATIVE","code_information":[{"code":"Px00030112235","type":"CDM"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM CDM","code_information":[{"code":"Px00030112248","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHOLESTEROL","code_information":[{"code":"Px00030112251","type":"CDM"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CHROMIUM","code_information":[{"code":"Px00030112254","type":"CDM"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CREATINE","code_information":[{"code":"Px00030112255","type":"CDM"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF CSF PROTEIN","code_information":[{"code":"Px00030112256","type":"CDM"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY TOTAL HYDROXYPROLINE","code_information":[{"code":"Px00030112257","type":"CDM"},{"code":"83505","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY URINE CATECHOLAMINES","code_information":[{"code":"Px00030112258","type":"CDM"},{"code":"82382","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE CLEARANCE","code_information":[{"code":"Px00030112259","type":"CDM"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG","code_information":[{"code":"Px00030112260","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC UREA NITROGEN CLEARANCE LAB","code_information":[{"code":"Px00030112261","type":"CDM"},{"code":"84545","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF APOLIPOPROTEIN B-100","code_information":[{"code":"Px00030112264","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GALACTOSE 1 PHOS URIDYL TRANSFERASE SCREEN","code_information":[{"code":"Px00030112271","type":"CDM"},{"code":"82776","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN E","code_information":[{"code":"Px00030112272","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PH BODY FLUID LAB","code_information":[{"code":"Px00030112273","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 CDM","code_information":[{"code":"Px00030112278","type":"CDM"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARBOXYHEMOGLOBIN","code_information":[{"code":"Px00030112287","type":"CDM"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF LEAD CDM","code_information":[{"code":"Px00030112289","type":"CDM"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":132.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RIA NONANTIBODY ACETYLCHOLINE BINDING AB","code_information":[{"code":"Px00030112297","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AMYLASE","code_information":[{"code":"Px00030112298","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BILE ACIDS FRACTIONATED","code_information":[{"code":"Px00030112299","type":"CDM"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":303.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LACTATE DEHYDROGENASE LDH CDM","code_information":[{"code":"Px00030112303","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACYLCARNITINES QUANT","code_information":[{"code":"Px00030112306","type":"CDM"},{"code":"82017","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HOMOCYSTEINE LAB","code_information":[{"code":"Px00030112310","type":"CDM"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC METHYLMALONIC ACID QUANTITATIVE LAB","code_information":[{"code":"Px00030112311","type":"CDM"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TOTAL PROTEIN","code_information":[{"code":"Px00030112314","type":"CDM"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANDROSTENEDIONE LAB","code_information":[{"code":"Px00030112315","type":"CDM"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF APOLIPOPROTEIN EACH","code_information":[{"code":"Px00030112316","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF FLUORIDE","code_information":[{"code":"Px00030112319","type":"CDM"},{"code":"82735","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL","code_information":[{"code":"Px00030112325","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE","code_information":[{"code":"Px00030112329","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HISTAMINE LAB","code_information":[{"code":"Px00030112330","type":"CDM"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PH URINE","code_information":[{"code":"Px00030112332","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROCAINAMIDE","code_information":[{"code":"Px00030112333","type":"CDM"},{"code":"80190","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE","code_information":[{"code":"Px00030112336","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY AMYLASE URINE","code_information":[{"code":"Px00030112344","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF BLOOD FATTY ACIDS","code_information":[{"code":"Px00030112349","type":"CDM"},{"code":"82725","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":240.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN","code_information":[{"code":"Px00030112351","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BETA 2 MICROGLOBULIN","code_information":[{"code":"Px00030112352","type":"CDM"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE OTHER SOURCE","code_information":[{"code":"Px00030112358","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENZYME CELL ACTIVITY LAB","code_information":[{"code":"Px00030112361","type":"CDM"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FAT/LIPIDS FECES QUANTITATIVE 72 HR","code_information":[{"code":"Px00030112362","type":"CDM"},{"code":"82710","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN E (IGE)","code_information":[{"code":"Px00030112366","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MYOGLOBIN SERUM","code_information":[{"code":"Px00030112373","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF OSMOLALITY BLOOD","code_information":[{"code":"Px00030112375","type":"CDM"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTITATION DRUG NOT ELSEWHERE SPECIFIED","code_information":[{"code":"Px00030112380","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTITATIVE ASSAY DRUG OXCARBAZEPINE","code_information":[{"code":"Px00030112381","type":"CDM"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SGOT (AST)","code_information":[{"code":"Px00030112384","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF UREA NITROGEN URINE","code_information":[{"code":"Px00030112388","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RIA NONANTIBODY ACETYLCHOLINE RECEPTOR","code_information":[{"code":"Px00030112390","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL URINE","code_information":[{"code":"Px00030112394","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMIKACIN","code_information":[{"code":"Px00030112403","type":"CDM"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CEA","code_information":[{"code":"Px00030112404","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHOLESTEROL BODY FLUID","code_information":[{"code":"Px00030112412","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CATECHOLAMINES FRACTIONATED","code_information":[{"code":"Px00030112425","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN CEA CDM","code_information":[{"code":"Px00030112474","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTI-CENTROMERE ANTIBODY","code_information":[{"code":"Px00030112483","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URIC ACID BODY FLUID","code_information":[{"code":"Px00030112538","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP LAB","code_information":[{"code":"Px00030112591","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PTH INTACT","code_information":[{"code":"Px00030112635","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ESTRONE CDM","code_information":[{"code":"Px00030112650","type":"CDM"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PTH","code_information":[{"code":"Px00030112655","type":"CDM"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TROPONIN I","code_information":[{"code":"Px00030112659","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TSH","code_information":[{"code":"Px00030112660","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TSH(THYROID STIMULATING HORMONE)","code_information":[{"code":"Px00030112661","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALBUMIN - OTHER","code_information":[{"code":"Px00030112668","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AMYLASE (BODY FLUID)","code_information":[{"code":"Px00030112671","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF AMYLASE CDM","code_information":[{"code":"Px00030112672","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BUN (BLOOD UREA NITROGEN)","code_information":[{"code":"Px00030112695","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BUN POST DIALYSIS","code_information":[{"code":"Px00030112696","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM (24HR UR)","code_information":[{"code":"Px00030112697","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM (CA)","code_information":[{"code":"Px00030112698","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CATECHOLAMINES FRACT -24HR UR","code_information":[{"code":"Px00030112699","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE 24 HR URINE LAB","code_information":[{"code":"Px00030112700","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE (CSF)","code_information":[{"code":"Px00030112701","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE OTHER SOURCE CDM","code_information":[{"code":"Px00030112702","type":"CDM"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE-URINE RANDOM","code_information":[{"code":"Px00030112703","type":"CDM"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CPK","code_information":[{"code":"Px00030112704","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE (24HR UR)","code_information":[{"code":"Px00030112705","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE (BODY FLUID)","code_information":[{"code":"Px00030112706","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE (RANDOM UR)","code_information":[{"code":"Px00030112707","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLYCATED PROTEIN FRUCTOSAMINE","code_information":[{"code":"Px00030112712","type":"CDM"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FSH(FOLLICLE STIMULATE HORMONE)","code_information":[{"code":"Px00030112713","type":"CDM"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE (BODY FLUID)","code_information":[{"code":"Px00030112716","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOLERANCE(3 SPEC)","code_information":[{"code":"Px00030112719","type":"CDM"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN GLYCOSYLATED A1C LAB","code_information":[{"code":"Px00030112722","type":"CDM"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HCG (QUANTITATIVE)","code_information":[{"code":"Px00030112723","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN A","code_information":[{"code":"Px00030112729","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LACTATE DEHYDROGENASE LDH BODY FLUID LAB","code_information":[{"code":"Px00030112735","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LDH BODY FLUID","code_information":[{"code":"Px00030112736","type":"CDM"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LUTEINIZING HORMORE (LH)","code_information":[{"code":"Px00030112737","type":"CDM"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MICROALBUMIN QUANTITATIVE RANDOM","code_information":[{"code":"Px00030112744","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MYOGLOBIN (SERUM)","code_information":[{"code":"Px00030112750","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MYOGLOBIN (UR)","code_information":[{"code":"Px00030112751","type":"CDM"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OSMOLALITY (UR)","code_information":[{"code":"Px00030112755","type":"CDM"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PH (BODY FLUID)","code_information":[{"code":"Px00030112756","type":"CDM"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM (24HR UR)","code_information":[{"code":"Px00030112758","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM(K)","code_information":[{"code":"Px00030112759","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN (CSF)","code_information":[{"code":"Px00030112761","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SODIUM (24HR UR)","code_information":[{"code":"Px00030112773","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SODIUM (RANDOM UR)","code_information":[{"code":"Px00030112774","type":"CDM"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE-TOTAL","code_information":[{"code":"Px00030112777","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF UREA NITROGEN 24 HR URINE LAB","code_information":[{"code":"Px00030112778","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URIC ACID (24HR UR)","code_information":[{"code":"Px00030112779","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE","code_information":[{"code":"Px00030112797","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACETYL RECEPT BLOCKING AB","code_information":[{"code":"Px00030112801","type":"CDM"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLINE REC BLOCKING AB","code_information":[{"code":"Px00030112805","type":"CDM"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AFP- AMNIOTIC FLUID","code_information":[{"code":"Px00030112816","type":"CDM"},{"code":"82106","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALDOSTERONE (SERUM)","code_information":[{"code":"Px00030112838","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AFP-L3 FRACTION ISOFORM & TOTAL AFP W/RATIO LAB","code_information":[{"code":"Px00030112854","type":"CDM"},{"code":"82107","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALT/SGPT","code_information":[{"code":"Px00030112856","type":"CDM"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AMINOLEVULINIC ACID DELTA UR","code_information":[{"code":"Px00030112874","type":"CDM"},{"code":"82135","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AMYLASE SERUM/URINE","code_information":[{"code":"Px00030112888","type":"CDM"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANGIOTENSIN CONVERT ENZ+C470(ACE)","code_information":[{"code":"Px00030112893","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANGIOTNSION I ENZYME TEST","code_information":[{"code":"Px00030112896","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":107.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030112898","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP ANTI-GLIADIN IGA LAB","code_information":[{"code":"Px00030112909","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTI-GLIADIN IGG OR IGM","code_information":[{"code":"Px00030112911","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ARSENIC (BLOOD)","code_information":[{"code":"Px00030112918","type":"CDM"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS","code_information":[{"code":"Px00030112932","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TRANSFERASE ASPARTATE AMINO AST SGOT LAB","code_information":[{"code":"Px00030112998","type":"CDM"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BETA-HYDROXYBUTRIC ACID","code_information":[{"code":"Px00030113017","type":"CDM"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN - BODY FLUID","code_information":[{"code":"Px00030113022","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BILIRUBIN TOTAL","code_information":[{"code":"Px00030113025","type":"CDM"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMETRY LAB","code_information":[{"code":"Px00030113036","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMETRY LAB","code_information":[{"code":"Px00030113037","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD UREA NITROGEN","code_information":[{"code":"Px00030113045","type":"CDM"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM QUANT UR TIMED","code_information":[{"code":"Px00030113072","type":"CDM"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM TOTAL CDM","code_information":[{"code":"Px00030113073","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCIUM-UR RANDOM","code_information":[{"code":"Px00030113080","type":"CDM"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CAPILLARY BLOOD GAS","code_information":[{"code":"Px00030113081","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CEA PANCREATIC CYST FLD","code_information":[{"code":"Px00030113094","type":"CDM"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLORIDE BLD CDM","code_information":[{"code":"Px00030113102","type":"CDM"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARBON DIOXIDE BICARBONATE LAB","code_information":[{"code":"Px00030113128","type":"CDM"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COPPER-BLOOD","code_information":[{"code":"Px00030113139","type":"CDM"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL (AM)","code_information":[{"code":"Px00030113140","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORTISOL (PM)","code_information":[{"code":"Px00030113142","type":"CDM"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CPK W/REFLEX","code_information":[{"code":"Px00030113157","type":"CDM"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CREATININE URINE","code_information":[{"code":"Px00030113167","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC C-TELOPEPTIDE CROSSLINK (CTXAR)","code_information":[{"code":"Px00030113181","type":"CDM"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FECAL FAT QUANT","code_information":[{"code":"Px00030113309","type":"CDM"},{"code":"82710","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GASES BLOOD W/ DIRECT MEASURE 02 SATURATION CDM","code_information":[{"code":"Px00030113346","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3","code_information":[{"code":"Px00030113347","type":"CDM"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GESTATIONAL GLUCOSE 1 HOUR","code_information":[{"code":"Px00030113354","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLOMERULAR BASE MEMBRAN AB-IGG","code_information":[{"code":"Px00030113360","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE (CSF)","code_information":[{"code":"Px00030113366","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE FASTING","code_information":[{"code":"Px00030113373","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP","code_information":[{"code":"Px00030113377","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE TOL-1 HR-OB","code_information":[{"code":"Px00030113381","type":"CDM"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLUCOSE URINE LAB","code_information":[{"code":"Px00030113387","type":"CDM"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GONADOTROPIN CHORIONIC HCG QUANT","code_information":[{"code":"Px00030113402","type":"CDM"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEAVY METAL QUANTIATIVE EACH NES LAB","code_information":[{"code":"Px00030113413","type":"CDM"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN CHROMOTOGRAPHY A2","code_information":[{"code":"Px00030113418","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN-PLASMA","code_information":[{"code":"Px00030113424","type":"CDM"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HSV WESTERN BLOT","code_information":[{"code":"Px00030113464","type":"CDM"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNO FOR ANALYTE OTHER THAN INF","code_information":[{"code":"Px00030113490","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":420.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP CDM","code_information":[{"code":"Px00030113493","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY NON-RIA","code_information":[{"code":"Px00030113496","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS LAB","code_information":[{"code":"Px00030113497","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN A (IGA)","code_information":[{"code":"Px00030113504","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN D(IGD)","code_information":[{"code":"Px00030113507","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE LAB","code_information":[{"code":"Px00030113510","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN G (IGG)","code_information":[{"code":"Px00030113511","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00030113513","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOGLOBULIN M (IGM)","code_information":[{"code":"Px00030113514","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF IRON CDM","code_information":[{"code":"Px00030113527","type":"CDM"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MAGNESIUM (24HR UR)","code_information":[{"code":"Px00030113581","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF MAGNESIUM CDM","code_information":[{"code":"Px00030113587","type":"CDM"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MERCURY BLD","code_information":[{"code":"Px00030113605","type":"CDM"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC METANEPHRINES-PLASMA","code_information":[{"code":"Px00030113624","type":"CDM"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MITOCHONRIAL M2 AB","code_information":[{"code":"Px00030113644","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OLIGOCL BANDS CSF/SERUM (OLIGB)","code_information":[{"code":"Px00030113718","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ORGANIC ACIDS QUANT EACH","code_information":[{"code":"Px00030113727","type":"CDM"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY","code_information":[{"code":"Px00030113740","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHORUS INORGANIC URINE","code_information":[{"code":"Px00030113750","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PHOSPHORUS INORGANIC RANDOM URINE LAB","code_information":[{"code":"Px00030113752","type":"CDM"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PORPHOBILINOGEN RANDON URINE","code_information":[{"code":"Px00030113758","type":"CDM"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PORPHYRINS URINE QUANTITATION & FRACTIONATION CDM","code_information":[{"code":"Px00030113766","type":"CDM"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM (RANDOM UR)","code_information":[{"code":"Px00030113779","type":"CDM"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM BODY FLUID LAB","code_information":[{"code":"Px00030113786","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROSTATIC SPECIFIC AG","code_information":[{"code":"Px00030113800","type":"CDM"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF PROTEIN 24HR URINE LAB","code_information":[{"code":"Px00030113803","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00030113810","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM CDM","code_information":[{"code":"Px00030113814","type":"CDM"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROPHORESIS-UR RANDOM","code_information":[{"code":"Px00030113816","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN OTH (24HR UR)","code_information":[{"code":"Px00030113821","type":"CDM"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN-UR RANDOM","code_information":[{"code":"Px00030113827","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC REFLEXIVE TSH","code_information":[{"code":"Px00030113885","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APOLIPOPROTEIN EACH CDM","code_information":[{"code":"Px00030113941","type":"CDM"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CATECHOLAMINES FRACTIONATED LAB","code_information":[{"code":"Px00030113956","type":"CDM"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH","code_information":[{"code":"Px00030113976","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HSV BY WESTERN BLOT","code_information":[{"code":"Px00030113982","type":"CDM"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","code_information":[{"code":"Px00030113983","type":"CDM"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SODIUM SERUM PLASMA OR WHOLE BLOOD","code_information":[{"code":"Px00030114096","type":"CDM"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SODIUM-BODY FLUID","code_information":[{"code":"Px00030114102","type":"CDM"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC POTASSIUM SERUM PLASMA/WHOLE BLOOD","code_information":[{"code":"Px00030114117","type":"CDM"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC STRIATIONAL (STR MUSCLE) ABS","code_information":[{"code":"Px00030114119","type":"CDM"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE -TOTAL","code_information":[{"code":"Px00030114149","type":"CDM"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF TESTOSTERONE FREE","code_information":[{"code":"Px00030114150","type":"CDM"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF THYROGLOBULIN LAB","code_information":[{"code":"Px00030114160","type":"CDM"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULT STEP TISSUE TRANSGLUT AB IGG LAB","code_information":[{"code":"Px00030114175","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE AB IGG/A","code_information":[{"code":"Px00030114177","type":"CDM"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE TOBRAMYCIN CDM","code_information":[{"code":"Px00030114183","type":"CDM"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TRIGLYCERIDES (BODY FLUID)","code_information":[{"code":"Px00030114195","type":"CDM"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TROPONIN-T","code_information":[{"code":"Px00030114201","type":"CDM"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TSH REFLEX TO FT4","code_information":[{"code":"Px00030114208","type":"CDM"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC UMBILICA VEIN BLOOD GAS","code_information":[{"code":"Px00030114215","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC UMBILICAL ARTERY BLOOD GAS","code_information":[{"code":"Px00030114216","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC UREA NITROGEN-UR RANDOM","code_information":[{"code":"Px00030114225","type":"CDM"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE","code_information":[{"code":"Px00030114229","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF URIC ACID OTHER SOURCE CDM","code_information":[{"code":"Px00030114230","type":"CDM"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VANILLYLMANDELIC ACID (VMA) URINE","code_information":[{"code":"Px00030114249","type":"CDM"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD GASES W O2 SATURATION VENOUS LAB","code_information":[{"code":"Px00030114253","type":"CDM"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED LAB","code_information":[{"code":"Px00030114260","type":"CDM"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VITAMIN E-TOCOPHEROL","code_information":[{"code":"Px00030114262","type":"CDM"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED","code_information":[{"code":"Px00030114263","type":"CDM"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANALGESICS NON-OPIOID 1 OR 2 ACETAMINOPHEN","code_information":[{"code":"Px00030114302","type":"CDM"},{"code":"80329","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANT TRICYCLIC 1/2 NORTRIPTYLINE LAB","code_information":[{"code":"Px00030114303","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANT TRICYCLIC 1/2 DESIPRAMINE","code_information":[{"code":"Px00030114304","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANT TRICYCLIC 1/2 IMIPRAMINE LAB","code_information":[{"code":"Px00030114305","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIDEPRESSANT TRICYCLIC 1/2 AMITRIPTYLINE LAB","code_information":[{"code":"Px00030114306","type":"CDM"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS LAB","code_information":[{"code":"Px00030114357","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC METHYL ALCOHOL","code_information":[{"code":"Px00030114358","type":"CDM"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV DIRECT OPT OBS PER DOS","code_information":[{"code":"Px00030114379","type":"CDM"},{"code":"80305","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS","code_information":[{"code":"Px00030114380","type":"CDM"},{"code":"80306","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR PER DOS","code_information":[{"code":"Px00030114381","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00030114382","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS","code_information":[{"code":"Px00030114383","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR CORDSTAT PER DOS","code_information":[{"code":"Px00030114389","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR ETHYLGLCURONIDE PER DOS","code_information":[{"code":"Px00030114390","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR MECONIUM PER DOS","code_information":[{"code":"Px00030114391","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM","code_information":[{"code":"Px00030114393","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR NICOTINE PER DOS LAB","code_information":[{"code":"Px00030114394","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR PER DOS","code_information":[{"code":"Px00030114395","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR NONCHROMO DRUGS OF ABUSE 8 PER DOS","code_information":[{"code":"Px00030114398","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR SALICYLATE PER DOS LAB","code_information":[{"code":"Px00030114403","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR TRICYCLICS PER DOS LAB","code_information":[{"code":"Px00030114406","type":"CDM"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TESTOSTERONE BIOAVAILABLE","code_information":[{"code":"Px00030114407","type":"CDM"},{"code":"84410","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA LAB","code_information":[{"code":"Px00030200108","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030200109","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030200113","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200114","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030200117","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A","code_information":[{"code":"Px00030200120","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200124","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200125","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030200126","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030200127","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA LAB","code_information":[{"code":"Px00030200128","type":"CDM"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":531.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA LAB","code_information":[{"code":"Px00030200129","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MUMPS LAB","code_information":[{"code":"Px00030200130","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200133","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200134","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200136","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA IGM LAB","code_information":[{"code":"Px00030200138","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA LAB","code_information":[{"code":"Px00030200139","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA LAB","code_information":[{"code":"Px00030200140","type":"CDM"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA LAB","code_information":[{"code":"Px00030200141","type":"CDM"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":531.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA LAB","code_information":[{"code":"Px00030200142","type":"CDM"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA IGM LAB","code_information":[{"code":"Px00030200143","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB","code_information":[{"code":"Px00030200149","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200152","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY LAB","code_information":[{"code":"Px00030200153","type":"CDM"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COXIELLA BURNETII Q FEVER LAB","code_information":[{"code":"Px00030200171","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COXIELLA BURNETII Q FEVER LAB","code_information":[{"code":"Px00030200172","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COXIELLA BURNETII Q FEVER LAB","code_information":[{"code":"Px00030200173","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COXIELLA BURNETII Q FEVER LAB","code_information":[{"code":"Px00030200174","type":"CDM"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HLA CLASS II PHENOTYPE PANEL QUAL LAB","code_information":[{"code":"Px00030200202","type":"CDM"},{"code":"86831","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA","code_information":[{"code":"Px00030200219","type":"CDM"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET ANTIBODIES LAB","code_information":[{"code":"Px00030200220","type":"CDM"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":286.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030200221","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC B CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200223","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200224","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200225","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO LAB","code_information":[{"code":"Px00030200226","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACTIN SMOOTH MUSCLE ANTIBODY EACH LAB","code_information":[{"code":"Px00030200274","type":"CDM"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200280","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200281","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200282","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200287","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200288","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200291","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200292","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200294","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200295","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200296","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200297","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MITOCHONDRIAL ANTIBODY EACH LAB","code_information":[{"code":"Px00030200300","type":"CDM"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB","code_information":[{"code":"Px00030200309","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB","code_information":[{"code":"Px00030200310","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB","code_information":[{"code":"Px00030200311","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200313","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200314","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200320","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200321","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200322","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENDOMYSIAL ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200345","type":"CDM"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200346","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200350","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200351","type":"CDM"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200352","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200353","type":"CDM"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENDOMYSIAL ANTIBODY EACH IMMUNOGLOBULIN CLASS LAB","code_information":[{"code":"Px00030200354","type":"CDM"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIEDLAB","code_information":[{"code":"Px00030200355","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIEDLAB","code_information":[{"code":"Px00030200356","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200358","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200359","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY EACH","code_information":[{"code":"Px00030200362","type":"CDM"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","code_information":[{"code":"Px00030200363","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","code_information":[{"code":"Px00030200364","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200365","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200366","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200414","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200415","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030200418","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INSULIN ANTIBODIES LAB","code_information":[{"code":"Px00030200419","type":"CDM"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOLOGY PROCEDURE LAB","code_information":[{"code":"Px00030200420","type":"CDM"},{"code":"86849","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUANT LAB","code_information":[{"code":"Px00030200428","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200429","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200452","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY LAB","code_information":[{"code":"Px00030200453","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED LAB","code_information":[{"code":"Px00030200464","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200465","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030200466","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH","code_information":[{"code":"Px00030200493","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200496","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200498","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200499","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200500","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030200502","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030200504","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN LAB","code_information":[{"code":"Px00030200505","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030200506","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200508","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200510","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200511","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030200512","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200514","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200515","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT LAB","code_information":[{"code":"Px00030200516","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED","code_information":[{"code":"Px00030200517","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY LAB","code_information":[{"code":"Px00030200523","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY LAB","code_information":[{"code":"Px00030200524","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS SERUM LAB","code_information":[{"code":"Px00030200526","type":"CDM"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200530","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INHIBIN A LAB","code_information":[{"code":"Px00030200532","type":"CDM"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY LAB","code_information":[{"code":"Px00030200534","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO LAB","code_information":[{"code":"Px00030200535","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MICROSOMAL ANTIBODIES EACH LAB","code_information":[{"code":"Px00030200536","type":"CDM"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200537","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200538","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANTITATIVE LAB","code_information":[{"code":"Px00030200539","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","code_information":[{"code":"Px00030200540","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","code_information":[{"code":"Px00030200541","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON","code_information":[{"code":"Px00030200542","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB","code_information":[{"code":"Px00030200543","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ACTINOMYCES LAB","code_information":[{"code":"Px00030200544","type":"CDM"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030200545","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030200546","type":"CDM"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030200547","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 1 LAB","code_information":[{"code":"Px00030200551","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX TYPE 2 LAB","code_information":[{"code":"Px00030200552","type":"CDM"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200553","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200554","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY PROTOZOA NES LAB","code_information":[{"code":"Px00030200556","type":"CDM"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RICKETTSIA LAB","code_information":[{"code":"Px00030200557","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200558","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200559","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM LAB","code_information":[{"code":"Px00030200560","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED LAB","code_information":[{"code":"Px00030200561","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030200562","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY","code_information":[{"code":"Px00030200563","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY","code_information":[{"code":"Px00030200564","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED LAB","code_information":[{"code":"Px00030200644","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200645","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200655","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB","code_information":[{"code":"Px00030200656","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC B CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200668","type":"CDM"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":177.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO LAB","code_information":[{"code":"Px00030200669","type":"CDM"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC T CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200670","type":"CDM"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NATURAL KILLER CELLS TOTAL COUNT LAB","code_information":[{"code":"Px00030200671","type":"CDM"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BLASTOMYCES LAB","code_information":[{"code":"Px00030200674","type":"CDM"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030200676","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED LAB","code_information":[{"code":"Px00030200677","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS LAB","code_information":[{"code":"Px00030200680","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY","code_information":[{"code":"Px00030200681","type":"CDM"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030200682","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200683","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200684","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB","code_information":[{"code":"Px00030200685","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030200686","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB LAB","code_information":[{"code":"Px00030200687","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY LAB","code_information":[{"code":"Px00030200688","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY","code_information":[{"code":"Px00030200689","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200717","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200718","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB LAB","code_information":[{"code":"Px00030200719","type":"CDM"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200737","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.0,"discounted_cash":734.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY LAB","code_information":[{"code":"Px00030200738","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.0,"discounted_cash":734.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030200773","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED LAB","code_information":[{"code":"Px00030200779","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BNDNG ANTB LAB","code_information":[{"code":"Px00030200821","type":"CDM"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BLCKG ANTB LAB","code_information":[{"code":"Px00030200822","type":"CDM"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BNDNG ANTB LAB","code_information":[{"code":"Px00030200829","type":"CDM"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR BLCKG ANTB LAB","code_information":[{"code":"Px00030200830","type":"CDM"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACETYLCHOLN RCPTR MODLG ANTB LAB","code_information":[{"code":"Px00030200831","type":"CDM"},{"code":"86043","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACTIN SMOOTH MUSCLE ANTIBODY EACH LAB","code_information":[{"code":"Px00030200882","type":"CDM"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030200899","type":"CDM"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BARTONELLA","code_information":[{"code":"Px00030201008","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BARTONELLA","code_information":[{"code":"Px00030201009","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB LAB","code_information":[{"code":"Px00030201046","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TOXOPLASMA IGM LAB","code_information":[{"code":"Px00030210035","type":"CDM"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBELLA LAB","code_information":[{"code":"Px00030210036","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN S QUANT","code_information":[{"code":"Px00030210086","type":"CDM"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA LAB","code_information":[{"code":"Px00030210107","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGG","code_information":[{"code":"Px00030210108","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACE-CSF","code_information":[{"code":"Px00030210115","type":"CDM"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IGG SUBCLASSES ADD CHG","code_information":[{"code":"Px00030210142","type":"CDM"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030210144","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LAMELLAR BODIES","code_information":[{"code":"Px00030210151","type":"CDM"},{"code":"83664","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPIDS-TOTAL","code_information":[{"code":"Px00030210163","type":"CDM"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN S FUNCTION (ACTIVITY)","code_information":[{"code":"Px00030210164","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HIV-1 AG W/HIV-1 & HIV-2 AB","code_information":[{"code":"Px00030210183","type":"CDM"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BARTONELLA LAB","code_information":[{"code":"Px00030210188","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030210195","type":"CDM"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","code_information":[{"code":"Px00030210205","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORRELIA BURGDORFERI LYME DISEASE LAB","code_information":[{"code":"Px00030210217","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST","code_information":[{"code":"Px00030210230","type":"CDM"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SARS COV-2 IMMUNE RESPONSE IGG","code_information":[{"code":"Px00030210241","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SARS COV-2 IMMUNE RESPONSE IGM","code_information":[{"code":"Px00030210242","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES LAB","code_information":[{"code":"Px00030210243","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030210247","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH LAB","code_information":[{"code":"Px00030210248","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY LAB","code_information":[{"code":"Px00030210249","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY LAB","code_information":[{"code":"Px00030210250","type":"CDM"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV LAB","code_information":[{"code":"Px00030210253","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV LAB","code_information":[{"code":"Px00030210254","type":"CDM"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV IGM LAB","code_information":[{"code":"Px00030210255","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY CYTOMEGALOVIRUS CMV IGM LAB","code_information":[{"code":"Px00030210256","type":"CDM"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST QUANTITATIVE LAB","code_information":[{"code":"Px00030210272","type":"CDM"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE","code_information":[{"code":"Px00030210302","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTI-SSA (RO) QUANTITATIVE","code_information":[{"code":"Px00030210311","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTI-SSB (LA) QUANTITATIVE","code_information":[{"code":"Px00030210312","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ARC ANTIGEN SCREEN-ANTIGEN","code_information":[{"code":"Px00030210318","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PRETX SERUM RBC ANTIBODY IDENTIFICATION DILUTION LAB","code_information":[{"code":"Px00030210331","type":"CDM"},{"code":"86976","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.33,"discounted_cash":45.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BARTONELLA ANTIBODY","code_information":[{"code":"Px00030210339","type":"CDM"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN PANEL RESPIRATORY RGN 17 CASCADE AND PACIFIC NW","code_information":[{"code":"Px00030210345","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST LAB","code_information":[{"code":"Px00030210348","type":"CDM"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MYCOPLSM CDM","code_information":[{"code":"Px00030210350","type":"CDM"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY IDENTIFICATION PLATELET IMMUNOGL ASSAY LAB","code_information":[{"code":"Px00030210353","type":"CDM"},{"code":"86023","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES (ANA) TITER","code_information":[{"code":"Px00030210354","type":"CDM"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM CDM","code_information":[{"code":"Px00030210360","type":"CDM"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY","code_information":[{"code":"Px00030210361","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES - ANA","code_information":[{"code":"Px00030210369","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ABSORPTION","code_information":[{"code":"Px00030210372","type":"CDM"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTISTREPTOLYSIN O TITER","code_information":[{"code":"Px00030210393","type":"CDM"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY IGG","code_information":[{"code":"Px00030210395","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTISTREPTOLYSIN O SCREEN LAB","code_information":[{"code":"Px00030210396","type":"CDM"},{"code":"86063","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY IGG LAB","code_information":[{"code":"Px00030210398","type":"CDM"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN","code_information":[{"code":"Px00030210399","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC C-REACTIVE PROTEIN - QUANTITATIVE","code_information":[{"code":"Px00030210403","type":"CDM"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY","code_information":[{"code":"Px00030210405","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS CDM","code_information":[{"code":"Px00030210408","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY EACH IG CLASS LAB","code_information":[{"code":"Px00030210409","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOLIPIN ANTIBODY - IGA","code_information":[{"code":"Px00030210412","type":"CDM"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT TOTAL HEMOLYTIC CDM","code_information":[{"code":"Px00030210418","type":"CDM"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":184.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID ANTIBODY","code_information":[{"code":"Px00030210419","type":"CDM"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLD AGGLUTININ SCREEN","code_information":[{"code":"Px00030210423","type":"CDM"},{"code":"86156","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLD AGGLUTININ TITER CDM","code_information":[{"code":"Px00030210424","type":"CDM"},{"code":"86157","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN - C3","code_information":[{"code":"Px00030210429","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN - C4","code_information":[{"code":"Px00030210430","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTI-DNA QUANTITATIVE","code_information":[{"code":"Px00030210432","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN2 - C3","code_information":[{"code":"Px00030210445","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN2 - C4","code_information":[{"code":"Px00030210447","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN EACH COMPONENT","code_information":[{"code":"Px00030210454","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEMENT ANTIGEN","code_information":[{"code":"Px00030210459","type":"CDM"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY - IGG","code_information":[{"code":"Px00030210467","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY","code_information":[{"code":"Px00030210468","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED","code_information":[{"code":"Px00030210470","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTI-SSDNA QUANTITATIVE","code_information":[{"code":"Px00030210473","type":"CDM"},{"code":"86226","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SCLERODERMA","code_information":[{"code":"Px00030210484","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SSA","code_information":[{"code":"Px00030210487","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - EXTRACTABLE AG ANTIBODY","code_information":[{"code":"Px00030210496","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD","code_information":[{"code":"Px00030210516","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030210518","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RHEUMATOID FACTOR QUANT","code_information":[{"code":"Px00030210522","type":"CDM"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HERPES SIMPLEX TEST - TYPE 1 IGG","code_information":[{"code":"Px00030210524","type":"CDM"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SCL 70","code_information":[{"code":"Px00030210527","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - JO 1","code_information":[{"code":"Px00030210528","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS","code_information":[{"code":"Px00030210529","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":481.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SSB","code_information":[{"code":"Px00030210534","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HETEROPHILE ANTIBODIES","code_information":[{"code":"Px00030210538","type":"CDM"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HETEROPHILE ANTIBODIES SCREEN LAB","code_information":[{"code":"Px00030210539","type":"CDM"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT - PNEUMOCOCCAL","code_information":[{"code":"Px00030210543","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN TETANUS CDM","code_information":[{"code":"Px00030210544","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS","code_information":[{"code":"Px00030210547","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT AB QUAN HEP B CDM","code_information":[{"code":"Px00030210564","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOASSAY INFECTIOUS AGENT - WEST NILE IGG","code_information":[{"code":"Px00030210566","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":317.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SERUM IMMUNOELECTROPHORESIS","code_information":[{"code":"Px00030210568","type":"CDM"},{"code":"86320","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OTHER IMMUNOELECTROPHORESIS","code_information":[{"code":"Px00030210569","type":"CDM"},{"code":"86325","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INTRINSIC FACTOR ANTIBODIES CDM","code_information":[{"code":"Px00030210572","type":"CDM"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INTRINSIC FACTOR ANTIBODY-AB","code_information":[{"code":"Px00030210573","type":"CDM"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PARTICLE AGGLUTINATION TEST - CRYPTOCOCCUS","code_information":[{"code":"Px00030210577","type":"CDM"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":277.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PARTICLE AGGLUTINATION TEST","code_information":[{"code":"Px00030210578","type":"CDM"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.0,"discounted_cash":305.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM","code_information":[{"code":"Px00030210598","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL","code_information":[{"code":"Px00030210605","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL - VDRL","code_information":[{"code":"Px00030210607","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASPERGILLUS ANTIBODY","code_information":[{"code":"Px00030210616","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS","code_information":[{"code":"Px00030210619","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BRUCELLA CDM","code_information":[{"code":"Px00030210627","type":"CDM"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COCCIDIOIDES ANTIBODY","code_information":[{"code":"Px00030210650","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY COCCIDIOIDES CDM","code_information":[{"code":"Px00030210651","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COCCIDIOIDES ANTIBODY LAB","code_information":[{"code":"Px00030210662","type":"CDM"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY DIPHTHERIA LAB","code_information":[{"code":"Px00030210664","type":"CDM"},{"code":"86648","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FUNGUS ANTIBODY","code_information":[{"code":"Px00030210707","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030210708","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HIV-1","code_information":[{"code":"Px00030210715","type":"CDM"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B SURF ANTIBODY HBSAB CDM","code_information":[{"code":"Px00030210735","type":"CDM"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":158.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS A ANTIBODY HAAB CDM","code_information":[{"code":"Px00030210737","type":"CDM"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MUMPS CDM","code_information":[{"code":"Px00030210744","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY MUMPS CDM","code_information":[{"code":"Px00030210745","type":"CDM"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTOZOA ANTIBODY NOS","code_information":[{"code":"Px00030210750","type":"CDM"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RICKETTSIA CDM","code_information":[{"code":"Px00030210757","type":"CDM"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBELLA CDM","code_information":[{"code":"Px00030210765","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RUBELLA ANTIBODY","code_information":[{"code":"Px00030210766","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY RUBELLA CDM","code_information":[{"code":"Px00030210769","type":"CDM"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY WEST NILE VIRUS IGM CDM","code_information":[{"code":"Px00030210773","type":"CDM"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WEST NILE VIRUS AB IGM - AB IGM","code_information":[{"code":"Px00030210774","type":"CDM"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY WEST NILE VIRUS CDM","code_information":[{"code":"Px00030210775","type":"CDM"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY WEST NILE VIRUS CDM","code_information":[{"code":"Px00030210776","type":"CDM"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VIRUS ANTIBODY NOS - HERPESVIRUS","code_information":[{"code":"Px00030210781","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VIRUS ANTIBODY NOS - PARAINFLUENZA 2","code_information":[{"code":"Px00030210783","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS DENGUE","code_information":[{"code":"Px00030210785","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY VIRUS HANTAVIRUS CDM","code_information":[{"code":"Px00030210786","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C ANTIBODY CDM","code_information":[{"code":"Px00030210798","type":"CDM"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY","code_information":[{"code":"Px00030210822","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.0,"discounted_cash":734.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH (D) LAB","code_information":[{"code":"Px00030210856","type":"CDM"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE LAB","code_information":[{"code":"Px00030210867","type":"CDM"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PRETX RBC ANTIBODY INCUBAT W/CHEM AGNTS/DRUGS EA","code_information":[{"code":"Px00030210878","type":"CDM"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.5,"discounted_cash":103.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPLITTING BLOOD/BLOOD PRODUCTS EACH UNIT LAB","code_information":[{"code":"Px00030210880","type":"CDM"},{"code":"86985","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASPERGILLUS AG EIA","code_information":[{"code":"Px00030210891","type":"CDM"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HTLV 1 AND 2  CDM","code_information":[{"code":"Px00030210894","type":"CDM"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HIV-1 ANTIGEN","code_information":[{"code":"Px00030210895","type":"CDM"},{"code":"87390","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGE - IGE QUANT","code_information":[{"code":"Px00030210904","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER LAB","code_information":[{"code":"Px00030210906","type":"CDM"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIGEN TYPING-UNIT","code_information":[{"code":"Px00030210908","type":"CDM"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING IMMUNFLUORESCENT","code_information":[{"code":"Px00030210911","type":"CDM"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030210913","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030210916","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHYSICIAN BLOOD BANK SERVICE - TRANSFUSION REACTION","code_information":[{"code":"Px00030210923","type":"CDM"},{"code":"86078","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":237.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUANTIFERON TB GOLD","code_information":[{"code":"Px00030210934","type":"CDM"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL - CSF","code_information":[{"code":"Px00030210935","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SYPHILIS TEST NON-TREP QUAL RPR","code_information":[{"code":"Px00030210936","type":"CDM"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL CDM","code_information":[{"code":"Px00030210943","type":"CDM"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HLA TYPING A/B/C MULTIPLE ANTIGENS LAB","code_information":[{"code":"Px00030210950","type":"CDM"},{"code":"86813","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.0,"discounted_cash":522.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CMV PCR QUALITATIVE","code_information":[{"code":"Px00030210986","type":"CDM"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DETECT AGENT NOS-DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030210995","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENTEROVIRUS PCR","code_information":[{"code":"Px00030211001","type":"CDM"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030211005","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030211006","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS B VIRUS QUANTIFICATION CDM","code_information":[{"code":"Px00030211009","type":"CDM"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS C GENOTYPING","code_information":[{"code":"Px00030211015","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2235.0,"discounted_cash":1564.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HERPES SIMPLEX PCR","code_information":[{"code":"Px00030211017","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HIV ULTRA SENSITIVE PCR","code_information":[{"code":"Px00030211020","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HSV PCR TYPING","code_information":[{"code":"Px00030211029","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","code_information":[{"code":"Px00030211031","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOBACTERIUM TB AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030211036","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA A SCREEN","code_information":[{"code":"Px00030211038","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA B SCREEN","code_information":[{"code":"Px00030211041","type":"CDM"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRSA PCR","code_information":[{"code":"Px00030211050","type":"CDM"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MYCOPLASMA PCR","code_information":[{"code":"Px00030211052","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NOROVIRUS AMP PROBE TQ EACH ORGANISM CDM","code_information":[{"code":"Px00030211053","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NOROVIRUS AMP PROBE TQ EACH ORGANISM CDM","code_information":[{"code":"Px00030211054","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPECIAL MICROBIOLOGY CULTURE","code_information":[{"code":"Px00030211061","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA S AUREUS AMPLIFIED PROBE TQ CDM","code_information":[{"code":"Px00030211062","type":"CDM"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA VARICELLA ZOSTER AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030211073","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THYROGLOBULIN ANTIBODY LAB","code_information":[{"code":"Px00030211075","type":"CDM"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORESCENT ANTIBODY SCREEN - NEURONAL","code_information":[{"code":"Px00030211076","type":"CDM"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFIXATION URINE","code_information":[{"code":"Px00030211079","type":"CDM"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ISLET CELL ANTIBODY CDM","code_information":[{"code":"Px00030211081","type":"CDM"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LYME DISEASE ANTIBODY - IGG-IGM","code_information":[{"code":"Px00030211082","type":"CDM"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEP C AB TEST CONFIRM","code_information":[{"code":"Px00030211089","type":"CDM"},{"code":"86804","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":567.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB","code_information":[{"code":"Px00030211109","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN PANEL RESPIRATORY RGN 17 CASCADE AND PACIFIC NW","code_information":[{"code":"Px00030211115","type":"CDM"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTINUCLEAR ANTIBODIES ANA LAB","code_information":[{"code":"Px00030211124","type":"CDM"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTISTREPTOLYSIN O TITER - STREPTOZYME TITER","code_information":[{"code":"Px00030211128","type":"CDM"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - RNP","code_information":[{"code":"Px00030211132","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RUBEOLA ANTIBODY - IGG","code_information":[{"code":"Px00030211133","type":"CDM"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - ENA SMITH","code_information":[{"code":"Px00030211136","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DNA ANTIBODY NATIVE/DOUBLE STRANDED LAB","code_information":[{"code":"Px00030211146","type":"CDM"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD LAB","code_information":[{"code":"Px00030211155","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY HELMINTH NOT ELSEWHERE SPECIFIED","code_information":[{"code":"Px00030211158","type":"CDM"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN LAB","code_information":[{"code":"Px00030211172","type":"CDM"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SARS-COV-2 COVID-19 ANTIBODY IGG/IGM MULTI STEP PROCESS LAB","code_information":[{"code":"Px00030211173","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SARS-COV-2 COVID-19 ANTIBODY IGM MULTI STEP PROCESS","code_information":[{"code":"Px00030211174","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTB SEVERE AQT RESPIR SYND SARS-COV-2 COVID-19","code_information":[{"code":"Px00030211175","type":"CDM"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030211227","type":"CDM"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY LAB","code_information":[{"code":"Px00030211228","type":"CDM"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ACTINOMYCES LAB","code_information":[{"code":"Px00030211229","type":"CDM"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY ASPERGILLUS LAB","code_information":[{"code":"Px00030211230","type":"CDM"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED LAB","code_information":[{"code":"Px00030211231","type":"CDM"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INFLUENZA A-B PCR","code_information":[{"code":"Px00030211511","type":"CDM"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTI-HIV 1/2 AB & P24 AG","code_information":[{"code":"Px00030211540","type":"CDM"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT RED BLOOD CELL AUTOMATED LAB","code_information":[{"code":"Px00030500013","type":"CDM"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHROMOGENIC SUBSTRATE ASSAY","code_information":[{"code":"Px00030500037","type":"CDM"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH","code_information":[{"code":"Px00030500041","type":"CDM"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA","code_information":[{"code":"Px00030500042","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT","code_information":[{"code":"Px00030500043","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT PLATELET AUTOMATED","code_information":[{"code":"Px00030500044","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500045","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EUGLOBULIN LYSIS LAB","code_information":[{"code":"Px00030500046","type":"CDM"},{"code":"85360","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPARIN ASSAY LAB","code_information":[{"code":"Px00030500048","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FACTOR INHIBITOR TEST LAB","code_information":[{"code":"Px00030500049","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FACTOR INHIBITOR TEST LAB","code_information":[{"code":"Px00030500050","type":"CDM"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHROMOGENIC SUBSTRATE ASSAY LAB","code_information":[{"code":"Px00030500052","type":"CDM"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR IX PTC/CHRISTMAS LAB","code_information":[{"code":"Px00030500063","type":"CDM"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME TITER","code_information":[{"code":"Px00030500085","type":"CDM"},{"code":"85675","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME TITER LAB","code_information":[{"code":"Px00030500086","type":"CDM"},{"code":"85675","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT PLATELET AUTOMATED LAB","code_information":[{"code":"Px00030500105","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLD COUNT SMEAR MCRSCP W/O MNL DIFRNTL WBC COUNT LAB","code_information":[{"code":"Px00030500111","type":"CDM"},{"code":"85008","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500136","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT","code_information":[{"code":"Px00030500137","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN","code_information":[{"code":"Px00030500138","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","code_information":[{"code":"Px00030500141","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC","code_information":[{"code":"Px00030500142","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500144","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500145","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED","code_information":[{"code":"Px00030500146","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTOMATED LAB","code_information":[{"code":"Px00030500147","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT PLATELET AUTOMATED LAB","code_information":[{"code":"Px00030500148","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR","code_information":[{"code":"Px00030500153","type":"CDM"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING FACTOR VIII AHG 1 STAGE LAB","code_information":[{"code":"Px00030500155","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY LAB","code_information":[{"code":"Px00030500156","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500168","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030500169","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION HEXAGONAL LAB","code_information":[{"code":"Px00030500190","type":"CDM"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030500214","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMATOCRIT LAB","code_information":[{"code":"Px00030500243","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT HEMOGLOBIN LAB","code_information":[{"code":"Px00030500244","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME LAB","code_information":[{"code":"Px00030510005","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030510006","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COAGULATION TIME ACTIVATED LAB","code_information":[{"code":"Px00030510013","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR LAB","code_information":[{"code":"Px00030510015","type":"CDM"},{"code":"85390","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COAGULATION TIME ACTIVATED","code_information":[{"code":"Px00030510020","type":"CDM"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FIBRINOGEN ACTIVITY","code_information":[{"code":"Px00030510021","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELET AGGREGATION IN VITRO EACH AGENT CDM","code_information":[{"code":"Px00030510022","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMOGLOBIN","code_information":[{"code":"Px00030510023","type":"CDM"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMATOCRIT","code_information":[{"code":"Px00030510024","type":"CDM"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MANUAL RETICULOCYTE COUNT","code_information":[{"code":"Px00030510026","type":"CDM"},{"code":"85044","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RBC SED RATE NONAUTOMATED","code_information":[{"code":"Px00030510027","type":"CDM"},{"code":"85651","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB","code_information":[{"code":"Px00030510029","type":"CDM"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AUTOMATED PLATELET COUNT","code_information":[{"code":"Px00030510030","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLD COUNT SMEAR MCRSCP W/O MNL DIFRNTL WBC COUNT LAB","code_information":[{"code":"Px00030510031","type":"CDM"},{"code":"85008","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME","code_information":[{"code":"Px00030510032","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL","code_information":[{"code":"Px00030510033","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BL SMEAR W/DIFF WBC COUNT","code_information":[{"code":"Px00030510034","type":"CDM"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VISCOSITY CDM","code_information":[{"code":"Px00030510035","type":"CDM"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AUTOMATED RETICULOCYTE COUNT","code_information":[{"code":"Px00030510037","type":"CDM"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPARIN ASSAY","code_information":[{"code":"Px00030510038","type":"CDM"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD CLOT FACTOR IX TEST","code_information":[{"code":"Px00030510040","type":"CDM"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030510042","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD CLOT INHIBITOR ASSAY","code_information":[{"code":"Px00030510043","type":"CDM"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ANTIGEN LAB","code_information":[{"code":"Px00030510046","type":"CDM"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":161.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AUTOMATED DIFF WBC COUNT","code_information":[{"code":"Px00030510047","type":"CDM"},{"code":"85004","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WBC ALKALINE PHOSPHATASE","code_information":[{"code":"Px00030510048","type":"CDM"},{"code":"85540","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030510049","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME","code_information":[{"code":"Px00030510050","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTITHROMBIN III TEST ANITGEN","code_information":[{"code":"Px00030510051","type":"CDM"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD CLOT FACTOR V TEST","code_information":[{"code":"Px00030510052","type":"CDM"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD CLOT FACTOR II TEST","code_information":[{"code":"Px00030510054","type":"CDM"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FIBRIN DGRADJ SPLT PRODUXS AGGLUJ SLIDE SEMIQUAN CDM","code_information":[{"code":"Px00030510055","type":"CDM"},{"code":"85362","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC REPTILASE TEST CDM","code_information":[{"code":"Px00030510056","type":"CDM"},{"code":"85635","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TEST","code_information":[{"code":"Px00030510058","type":"CDM"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD CLOT FACTOR XII TEST","code_information":[{"code":"Px00030510059","type":"CDM"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACTIVATED PROTEIN C APC RESISTANCE ASSAY LAB","code_information":[{"code":"Px00030510060","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLETE CBC AUTOMATED","code_information":[{"code":"Px00030510062","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FIBRINOGEN","code_information":[{"code":"Px00030510063","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD CLOT FACTOR VIII TEST ANTIGEN","code_information":[{"code":"Px00030510065","type":"CDM"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FIBRIN DEGRADATION QUANT","code_information":[{"code":"Px00030510069","type":"CDM"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION PLATELET LAB","code_information":[{"code":"Px00030510070","type":"CDM"},{"code":"85597","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE CDM","code_information":[{"code":"Px00030510071","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD CLOT FACTOR VIII TEST FACTOR","code_information":[{"code":"Px00030510072","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EUGLOBULIN LYSIS LAB","code_information":[{"code":"Px00030510073","type":"CDM"},{"code":"85360","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY CDM","code_information":[{"code":"Px00030510074","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030510075","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RBC SED RATE AUTOMATED","code_information":[{"code":"Px00030510076","type":"CDM"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AUTOMATED RBC COUNT","code_information":[{"code":"Px00030510077","type":"CDM"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FIBRIN DEGRADE SEMIQUANT","code_information":[{"code":"Px00030510080","type":"CDM"},{"code":"85378","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELET COUNT","code_information":[{"code":"Px00030510082","type":"CDM"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE CDM","code_information":[{"code":"Px00030510083","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACTIVATED PROTEIN C APC RESISTANCE ASSAY CDM","code_information":[{"code":"Px00030510084","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FACTOR VIII","code_information":[{"code":"Px00030510085","type":"CDM"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SICKLING RBC REDUCTION LAB","code_information":[{"code":"Px00030510092","type":"CDM"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EOSINOPHIL COUNT WHOLE BLOOD","code_information":[{"code":"Px00030510116","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB","code_information":[{"code":"Px00030510133","type":"CDM"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE LAB","code_information":[{"code":"Px00030510141","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WBC","code_information":[{"code":"Px00030510147","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELET AGGREGATION IN VITRO EACH AGENT","code_information":[{"code":"Px00030510149","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACTIVATED PROTEIN C RESISTANCE","code_information":[{"code":"Px00030510150","type":"CDM"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY CDM","code_information":[{"code":"Px00030510152","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTI-THROMBIN III ACTIVITY","code_information":[{"code":"Px00030510153","type":"CDM"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTITHROMBIN III ANTIGEN","code_information":[{"code":"Px00030510155","type":"CDM"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CBC WITH NO DIFFERENTIAL","code_information":[{"code":"Px00030510167","type":"CDM"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FETAL CELL STAIN QUANT","code_information":[{"code":"Px00030510193","type":"CDM"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FIBRINOLYTIC PLASMINOGEN 2","code_information":[{"code":"Px00030510196","type":"CDM"},{"code":"85420","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTHROMBIN TIME WHOLE BLOOD","code_information":[{"code":"Px00030510203","type":"CDM"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030510207","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELET AGGREGATION EA AGENT","code_information":[{"code":"Px00030510217","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELET AGGREGATION IN VITRO EACH AGENT LAB","code_information":[{"code":"Px00030510219","type":"CDM"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN S FREE LAB","code_information":[{"code":"Px00030510233","type":"CDM"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR LAB","code_information":[{"code":"Px00030510244","type":"CDM"},{"code":"85390","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":34.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PTT 1 TO 1 MIX","code_information":[{"code":"Px00030510252","type":"CDM"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FIBRINOGEN ACTIVITY LAB","code_information":[{"code":"Px00030510255","type":"CDM"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBIN TIME PLASMA LAB","code_information":[{"code":"Px00030510287","type":"CDM"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WBC AUTO","code_information":[{"code":"Px00030510310","type":"CDM"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO STREPTOCOCCUS GROUP B LAB","code_information":[{"code":"Px00030510311","type":"CDM"},{"code":"87802","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOTTING INHIBITORS PROTEIN C ACTIVITY LAB","code_information":[{"code":"Px00030510353","type":"CDM"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRYSTAL ID LIGHT MICROSCOPY ALYS JOINT FLUID","code_information":[{"code":"Px00030510409","type":"CDM"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORONAVIRUS AG IA LAB","code_information":[{"code":"Px00030600007","type":"CDM"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT DS 22TRGT SARS-COV-2 BIOFIRE LAB","code_information":[{"code":"Px00030600009","type":"CDM"},{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":1165.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS","code_information":[{"code":"Px00030600044","type":"CDM"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SARSCOV2 & INF A&B AMP PRB","code_information":[{"code":"Px00030600052","type":"CDM"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600090","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600091","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600092","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600093","type":"CDM"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM LAB","code_information":[{"code":"Px00030600094","type":"CDM"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600108","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600109","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM LAB","code_information":[{"code":"Px00030600110","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":333.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL LAB","code_information":[{"code":"Px00030600138","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":120.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","code_information":[{"code":"Px00030600149","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES LAB","code_information":[{"code":"Px00030600150","type":"CDM"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600155","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600156","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600157","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600158","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600159","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600160","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030600161","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600162","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600163","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600164","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600165","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600166","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600167","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600168","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD LAB","code_information":[{"code":"Px00030600169","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600170","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600171","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600172","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600173","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600174","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030600175","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600236","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC WET MOUNT NFCT AGT LAB","code_information":[{"code":"Px00030600237","type":"CDM"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":82.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600274","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600275","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC SPEC STAIN BODIES/PARASITS LAB","code_information":[{"code":"Px00030600281","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600284","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":356.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT LAB","code_information":[{"code":"Px00030600285","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ADENOVIRUS DNA QUANTITATIVE RT-PCR LAB","code_information":[{"code":"Px00030600288","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":292.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BK VIRUS QUANTITATIVE URINE LAB","code_information":[{"code":"Px00030600291","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID","code_information":[{"code":"Px00030600302","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BK VIRUS PLASMA QUANT PCR LAB","code_information":[{"code":"Px00030600317","type":"CDM"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SARSCOV2 & INF A&B AMP PRB LAB","code_information":[{"code":"Px00030600318","type":"CDM"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAADI LEGIONELLA PNEUMOPHILA LAB","code_information":[{"code":"Px00030600328","type":"CDM"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600331","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL LAB","code_information":[{"code":"Px00030600332","type":"CDM"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL","code_information":[{"code":"Px00030600333","type":"CDM"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":32.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600362","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600363","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600364","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600365","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600366","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600369","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600370","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600371","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB","code_information":[{"code":"Px00030600372","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT LAB","code_information":[{"code":"Px00030600377","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT LAB","code_information":[{"code":"Px00030600378","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TOXIN/ANTITOXIN ASSAY TISSUE CULTURE LAB","code_information":[{"code":"Px00030600379","type":"CDM"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600380","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS LAB","code_information":[{"code":"Px00030600382","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS","code_information":[{"code":"Px00030600383","type":"CDM"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA CANDIDA SPECIES DIRECT PROBE TQ LAB","code_information":[{"code":"Px00030600384","type":"CDM"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ LAB","code_information":[{"code":"Px00030600386","type":"CDM"},{"code":"87510","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600388","type":"CDM"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600390","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600391","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600392","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600394","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600395","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES","code_information":[{"code":"Px00030600396","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600397","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600400","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600403","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600404","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600405","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO NOT OTHERWISE SPECIFIED LAB","code_information":[{"code":"Px00030600406","type":"CDM"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS","code_information":[{"code":"Px00030600409","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2235.0,"discounted_cash":1564.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS LAB","code_information":[{"code":"Px00030600410","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2235.0,"discounted_cash":1564.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS LAB","code_information":[{"code":"Px00030600411","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2235.0,"discounted_cash":1564.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB","code_information":[{"code":"Px00030600417","type":"CDM"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.0,"discounted_cash":445.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS LAB","code_information":[{"code":"Px00030600418","type":"CDM"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2235.0,"discounted_cash":1564.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING ID BLD PTHGN&RESIST TYPING GTE 6 TRGT LAB","code_information":[{"code":"Px00030600419","type":"CDM"},{"code":"87154","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.0,"discounted_cash":596.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600428","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600431","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600432","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030600435","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600447","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TOXIN/ANTITOXIN ASSAY TISSUE CULTURE","code_information":[{"code":"Px00030600449","type":"CDM"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT LAB","code_information":[{"code":"Px00030600470","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL LAB","code_information":[{"code":"Px00030600527","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HOMOGENIZATION TISSUE CULTURE LAB","code_information":[{"code":"Px00030600528","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB","code_information":[{"code":"Px00030600529","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ LAB","code_information":[{"code":"Px00030600533","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030600619","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ LAB","code_information":[{"code":"Px00030600699","type":"CDM"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":437.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB","code_information":[{"code":"Px00030600738","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":104.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600749","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":104.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600750","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":104.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB","code_information":[{"code":"Px00030600751","type":"CDM"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":104.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT CDM","code_information":[{"code":"Px00030610035","type":"CDM"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030610056","type":"CDM"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610058","type":"CDM"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA GARDNERELLA VAGINALIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610059","type":"CDM"},{"code":"87511","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0099ULAB","code_information":[{"code":"Px00030610075","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM BIOFIRE PLA 0099ULAB","code_information":[{"code":"Px00030610076","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0099ULAB","code_information":[{"code":"Px00030610077","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 20 TARGET BIOFIRE PLA 0099ULAB","code_information":[{"code":"Px00030610078","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":1221.0,"discounted_cash":854.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0100U","code_information":[{"code":"Px00030610080","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM BIOFIRE PLA 0100U","code_information":[{"code":"Px00030610081","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0100U","code_information":[{"code":"Px00030610082","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE AND REV TRNSCR 21 TARGET PLA BIOFIRE PLA 0100","code_information":[{"code":"Px00030610083","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":1221.0,"discounted_cash":854.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610091","type":"CDM"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00030610092","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":90.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610093","type":"CDM"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION LAB","code_information":[{"code":"Px00030610094","type":"CDM"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS LAB","code_information":[{"code":"Px00030610096","type":"CDM"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HIV-1 DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030610106","type":"CDM"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610111","type":"CDM"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC N.GONORRHOEAE DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030610129","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC N.GONORRHOEAE DNA APTIMA2","code_information":[{"code":"Px00030610131","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OVA AND PARASITES EXAM","code_information":[{"code":"Px00030610133","type":"CDM"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PERTUSSIS BY PCR","code_information":[{"code":"Px00030610137","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA ROTAVIRUS CDM","code_information":[{"code":"Px00030610142","type":"CDM"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":152.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TRICHROME STAIN","code_information":[{"code":"Px00030610151","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 21 TARGET BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610152","type":"CDM"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":1162.0,"discounted_cash":813.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC UNLISTED MICRO PROCEDURE","code_information":[{"code":"Px00030610166","type":"CDM"},{"code":"87999","type":"HCPCS"}],"standard_charges":[{"gross_charge":4077.0,"discounted_cash":2853.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA WEST NILE VIRUS AMP PROBE TQ EA ORG CDM","code_information":[{"code":"Px00030610167","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM","code_information":[{"code":"Px00030610178","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610182","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM BIOFIRE PLA 0100ULAB","code_information":[{"code":"Px00030610183","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS LAB","code_information":[{"code":"Px00030610189","type":"CDM"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030610191","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610192","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ","code_information":[{"code":"Px00030610194","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610195","type":"CDM"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM LAB","code_information":[{"code":"Px00030610199","type":"CDM"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS","code_information":[{"code":"Px00030610277","type":"CDM"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD CULTURE FOR BACTERIA","code_information":[{"code":"Px00030610301","type":"CDM"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL CDM","code_information":[{"code":"Px00030610304","type":"CDM"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA CDM","code_information":[{"code":"Px00030610308","type":"CDM"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA CDM","code_information":[{"code":"Px00030610309","type":"CDM"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM","code_information":[{"code":"Px00030610315","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIA OTHER","code_information":[{"code":"Px00030610321","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIA OTHER- BODY FLUID","code_information":[{"code":"Px00030610322","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIA OTHER - CSF","code_information":[{"code":"Px00030610326","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIA OTHER - RESPIRATORY","code_information":[{"code":"Px00030610330","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE-RESPIR UPPER","code_information":[{"code":"Px00030610331","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE-WOUND-SURFACE","code_information":[{"code":"Px00030610333","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE-SURGICAL TISSUE","code_information":[{"code":"Px00030610337","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE BACTERIA OTHER - CENTRAL LINE","code_information":[{"code":"Px00030610342","type":"CDM"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL","code_information":[{"code":"Px00030610356","type":"CDM"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM","code_information":[{"code":"Px00030610358","type":"CDM"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL","code_information":[{"code":"Px00030610359","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL CDM","code_information":[{"code":"Px00030610366","type":"CDM"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ CDM","code_information":[{"code":"Px00030610380","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY - YERSINIA","code_information":[{"code":"Px00030610382","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY - HELICOBACTER PYLORI","code_information":[{"code":"Px00030610383","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY","code_information":[{"code":"Px00030610387","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ CDM","code_information":[{"code":"Px00030610389","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY - MRSA /MSSA","code_information":[{"code":"Px00030610391","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ CDM","code_information":[{"code":"Px00030610392","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY - BACTERIA SCREEN","code_information":[{"code":"Px00030610394","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE SCREEN ONLY - PERTUSSIS","code_information":[{"code":"Px00030610409","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URINE CULTURE/COLONY COUNT","code_information":[{"code":"Px00030610417","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URINE BACTERIA CULTURE","code_information":[{"code":"Px00030610419","type":"CDM"},{"code":"87088","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL","code_information":[{"code":"Px00030610420","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FUNGUS ISOLATION CULTURE - YEAST","code_information":[{"code":"Px00030610421","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE-YEAST","code_information":[{"code":"Px00030610422","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FUNGUS ISOLATION CULTURE","code_information":[{"code":"Px00030610423","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD","code_information":[{"code":"Px00030610426","type":"CDM"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD CDM","code_information":[{"code":"Px00030610432","type":"CDM"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST LAB","code_information":[{"code":"Px00030610436","type":"CDM"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST LAB","code_information":[{"code":"Px00030610442","type":"CDM"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD","code_information":[{"code":"Px00030610444","type":"CDM"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":143.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MYCOBACTERIA CULTURE - AFB CULTURE","code_information":[{"code":"Px00030610448","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES LAB","code_information":[{"code":"Px00030610463","type":"CDM"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE HOMOGENIZATION CULTR","code_information":[{"code":"Px00030610478","type":"CDM"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610482","type":"CDM"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ LAB","code_information":[{"code":"Px00030610483","type":"CDM"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MICROBE SUSCEPTIBLE DISK - KIRBY-BAUER","code_information":[{"code":"Px00030610490","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD","code_information":[{"code":"Px00030610491","type":"CDM"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030610504","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ LAB","code_information":[{"code":"Px00030610547","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ LAB","code_information":[{"code":"Px00030610551","type":"CDM"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMEAR GRAM STAIN","code_information":[{"code":"Px00030610563","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMEAR GRAM STAIN - HFPA FECAL LEUKOCYTES","code_information":[{"code":"Px00030610568","type":"CDM"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC KOHEXAM","code_information":[{"code":"Px00030610574","type":"CDM"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE EXAM FOR FUNGI - HAIR/NAIL/SKIN","code_information":[{"code":"Px00030610576","type":"CDM"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE EXAM FOR FUNGI KOH-TISSUE","code_information":[{"code":"Px00030610577","type":"CDM"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CLOSTRIDIUM AG EIA","code_information":[{"code":"Px00030610581","type":"CDM"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GIARDIA ANTIGEN","code_information":[{"code":"Px00030610583","type":"CDM"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA INFLUENZA A/B EACH CDM","code_information":[{"code":"Px00030610591","type":"CDM"},{"code":"87400","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC B BURGDORFERI PCR","code_information":[{"code":"Px00030610594","type":"CDM"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.0,"discounted_cash":376.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA NOT OTHERWISE SPECIFIED EACH ORGANISM CDM","code_information":[{"code":"Px00030610595","type":"CDM"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE-ANAEROBE","code_information":[{"code":"Px00030610600","type":"CDM"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PNEUMOCOCCAL AB IGG","code_information":[{"code":"Px00030610601","type":"CDM"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL LAB","code_information":[{"code":"Px00030610605","type":"CDM"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE STOOL ADDITIONAL PATH","code_information":[{"code":"Px00030610606","type":"CDM"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE-YERSINIA","code_information":[{"code":"Px00030610621","type":"CDM"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CULTURE-URINE","code_information":[{"code":"Px00030610634","type":"CDM"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URINE-ISO-ID","code_information":[{"code":"Px00030610636","type":"CDM"},{"code":"87088","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FUNGUS CULTURE-HAIR NAIL SKIN","code_information":[{"code":"Px00030610637","type":"CDM"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MYCOBACTERIA CULTURE AFB BLOOD LAB","code_information":[{"code":"Px00030610646","type":"CDM"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SUSCEPTIBILITY - MIC","code_information":[{"code":"Px00030610651","type":"CDM"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HPYLORI STOOL CDM","code_information":[{"code":"Px00030610663","type":"CDM"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":231.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AFB STAIN","code_information":[{"code":"Px00030610665","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB","code_information":[{"code":"Px00030610668","type":"CDM"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALCOFLUOR STAIN","code_information":[{"code":"Px00030610672","type":"CDM"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB","code_information":[{"code":"Px00030610674","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHLAMYDIA TRACHOMATIS APTIMA2","code_information":[{"code":"Px00030610675","type":"CDM"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CMV AMPLIFIED PROBE","code_information":[{"code":"Px00030610679","type":"CDM"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CMV AMPLIFIED PROBE 2","code_information":[{"code":"Px00030610680","type":"CDM"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRYPTOSPORIDIUM ANTIGEN","code_information":[{"code":"Px00030610682","type":"CDM"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENTEROVIRUS DNA AMPLIFIED PROBE","code_information":[{"code":"Px00030610688","type":"CDM"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENTEROVIRUS DNA AMPLIFIED PROBE BY RT","code_information":[{"code":"Px00030610689","type":"CDM"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GIARDIA/CRYPTOSPORIDIUM AG","code_information":[{"code":"Px00030610696","type":"CDM"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HEPATITIS B VIRUS QUANTIFICATION LAB","code_information":[{"code":"Px00030610698","type":"CDM"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEPATITIS B SERUM ANTIGEN","code_information":[{"code":"Px00030610699","type":"CDM"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT AGENT DETECTION GI","code_information":[{"code":"Px00030610701","type":"CDM"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":334.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB","code_information":[{"code":"Px00030610705","type":"CDM"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY LAB","code_information":[{"code":"Px00030610706","type":"CDM"},{"code":"87625","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES CDM","code_information":[{"code":"Px00030610707","type":"CDM"},{"code":"87806","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DNA PROBE TYPE 12-25","code_information":[{"code":"Px00030610971","type":"CDM"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2527.0,"discounted_cash":1768.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700003","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700014","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB","code_information":[{"code":"Px00030700015","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB","code_information":[{"code":"Px00030700016","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB","code_information":[{"code":"Px00030700017","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URINALYSIS AUTO W/O SCOPE","code_information":[{"code":"Px00030710008","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM","code_information":[{"code":"Px00030710009","type":"CDM"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MICROSCOPIC EXAM OF URINE","code_information":[{"code":"Px00030710010","type":"CDM"},{"code":"81015","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FAT/LIPIDS FECES QUALITATIVE CDM","code_information":[{"code":"Px00030710011","type":"CDM"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPECIFIC GRAVITY URINE","code_information":[{"code":"Px00030710023","type":"CDM"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FAT URINE QUALITATIVE","code_information":[{"code":"Px00030710101","type":"CDM"},{"code":"89125","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SEMEN ANALYSIS","code_information":[{"code":"Px00030710102","type":"CDM"},{"code":"89320","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT CDM","code_information":[{"code":"Px00030910102","type":"CDM"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPECIMEN FAT STAIN","code_information":[{"code":"Px00030910108","type":"CDM"},{"code":"89125","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CNS DNA/RNA AMP PROBE MULTIPLE SUBTYPES 12-25 CDM","code_information":[{"code":"Px00030910201","type":"CDM"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2527.0,"discounted_cash":1768.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00031000047","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CONCENTRATION INFECTIOUS AGENTS LAB","code_information":[{"code":"Px00031000060","type":"CDM"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS LAB","code_information":[{"code":"Px00031000072","type":"CDM"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR LAB","code_information":[{"code":"Px00031000073","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":1544.0,"discounted_cash":1080.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN LAB","code_information":[{"code":"Px00031000093","type":"CDM"},{"code":"80503","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT LAB","code_information":[{"code":"Px00031000104","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031000107","type":"CDM"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","code_information":[{"code":"Px00031000144","type":"CDM"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ELECTRON MICROSCOPY DIAGNOSTIC LAB","code_information":[{"code":"Px00031000146","type":"CDM"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":387.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR LAB","code_information":[{"code":"Px00031000152","type":"CDM"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 LAB","code_information":[{"code":"Px00031000166","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC JAK2 TARGETED SEQUENCE ANALYSIS LAB","code_information":[{"code":"Px00031000167","type":"CDM"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MPL GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031000168","type":"CDM"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT LAB","code_information":[{"code":"Px00031000182","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC F2 GENE ANALYSIS 20210G >A VARIANT LAB","code_information":[{"code":"Px00031000203","type":"CDM"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CFTR GENE ANALYSIS COMMON VARIANTS LAB","code_information":[{"code":"Px00031000230","type":"CDM"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":543.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NATRIURETIC PEPTIDE LAB","code_information":[{"code":"Px00031000324","type":"CDM"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROSTATE BIOPSY ANY MTHD LAB","code_information":[{"code":"Px00031010110","type":"CDM"},{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION","code_information":[{"code":"Px00031010115","type":"CDM"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":557.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP SMRS ANY OTH SRC SCR&INTERPJ","code_information":[{"code":"Px00031010116","type":"CDM"},{"code":"88160","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC QUICK STAIN","code_information":[{"code":"Px00031010117","type":"CDM"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BCL2-FLOW","code_information":[{"code":"Px00031010119","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CCD22 FLOW","code_information":[{"code":"Px00031010120","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD71 FLOW","code_information":[{"code":"Px00031010121","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TCRAB FLOW","code_information":[{"code":"Px00031010122","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TCRGD FLOW","code_information":[{"code":"Px00031010123","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MDS SUREPATH PAP FOCAL POINT","code_information":[{"code":"Px00031010124","type":"CDM"},{"code":"G0145","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SCREEN CERV/VAG THIN LAYER","code_information":[{"code":"Px00031010190","type":"CDM"},{"code":"G0123","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ADDITIONAL KAROTYPE","code_information":[{"code":"Px00031010201","type":"CDM"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BAL DIFFERENTIAL TECH","code_information":[{"code":"Px00031010206","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BILL SURG LEVEL 2","code_information":[{"code":"Px00031010233","type":"CDM"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD103 FLOW","code_information":[{"code":"Px00031010254","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD16 FLOW","code_information":[{"code":"Px00031010255","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD2 FLOW","code_information":[{"code":"Px00031010256","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD23 FLOW","code_information":[{"code":"Px00031010257","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD24 FLOW","code_information":[{"code":"Px00031010258","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD3 FLOW","code_information":[{"code":"Px00031010259","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD4 FLOW","code_information":[{"code":"Px00031010260","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD45 FLOW","code_information":[{"code":"Px00031010261","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD5 FLOW","code_information":[{"code":"Px00031010262","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD57 FLOW STANDALONE TEST","code_information":[{"code":"Px00031010264","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD58 FLOW","code_information":[{"code":"Px00031010265","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD59 FLOW","code_information":[{"code":"Px00031010266","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CD79A FLOW","code_information":[{"code":"Px00031010267","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CDIIC FLOW","code_information":[{"code":"Px00031010270","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CELL BLOCK","code_information":[{"code":"Px00031010273","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME ANALYSIS","code_information":[{"code":"Px00031010279","type":"CDM"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME ANALYSIS 15-20 CELLS","code_information":[{"code":"Px00031010281","type":"CDM"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.0,"discounted_cash":824.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHRMSM ANALYSIS ADDL CELLS COUNTED EACH STUDY LAB","code_information":[{"code":"Px00031010289","type":"CDM"},{"code":"88285","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHRMSM ANALYSIS ADDL SPECIALIZED BANDING LAB","code_information":[{"code":"Px00031010290","type":"CDM"},{"code":"88283","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING","code_information":[{"code":"Px00031010297","type":"CDM"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.0,"discounted_cash":824.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHROMOSOME CULTURE HARVEST","code_information":[{"code":"Px00031010298","type":"CDM"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":423.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ LAB","code_information":[{"code":"Px00031010312","type":"CDM"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTO FLUIDS/WASHING/BRUSHING NON GYN","code_information":[{"code":"Px00031010313","type":"CDM"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTOPATH BETHESDA CERV/VAG MANUAL","code_information":[{"code":"Px00031010324","type":"CDM"},{"code":"88164","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V LAB","code_information":[{"code":"Px00031010325","type":"CDM"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTOPATH CER/VAG MANUAL SCREENING","code_information":[{"code":"Px00031010326","type":"CDM"},{"code":"88150","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL LAB","code_information":[{"code":"Px00031010327","type":"CDM"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTOPATH CERV/VAG AUTOMATED","code_information":[{"code":"Px00031010328","type":"CDM"},{"code":"88147","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT LAB","code_information":[{"code":"Px00031010330","type":"CDM"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP SMRS ANY OTH SRC EXTND STD GT 5 SLIDES","code_information":[{"code":"Px00031010335","type":"CDM"},{"code":"88162","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTOPATH SMEAR OTHER SOURCE PREP/SCREEN","code_information":[{"code":"Px00031010337","type":"CDM"},{"code":"88161","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP CONCENTRATION SMEARS & INTERPRETATION TECH LAB","code_information":[{"code":"Px00031010339","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP SMRS ANY OTH SRC SCR&INTERPJ LAB","code_information":[{"code":"Px00031010340","type":"CDM"},{"code":"88160","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DECALCIFICATION PROCEDURE LAB","code_information":[{"code":"Px00031010341","type":"CDM"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ELECTRON MICROSCOPY DIAGNOSTIC LAB","code_information":[{"code":"Px00031010348","type":"CDM"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FETAL HEMOGLOBIN  FIRST MARKER","code_information":[{"code":"Px00031010358","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLAER FLOW","code_information":[{"code":"Px00031010363","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY INTERPRETATION GTE 16 MARKERS","code_information":[{"code":"Px00031010364","type":"CDM"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY INTERPJ 2-8 MARKERS LAB","code_information":[{"code":"Px00031010365","type":"CDM"},{"code":"88187","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY INTERPJ 9-15 MARKERS","code_information":[{"code":"Px00031010366","type":"CDM"},{"code":"88188","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FMC7 FLOW","code_information":[{"code":"Px00031010369","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN LAB","code_information":[{"code":"Px00031010379","type":"CDM"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE LAB","code_information":[{"code":"Px00031010386","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IN SITU HYBRIDIZATION 1ST PROBE STAIN LAB","code_information":[{"code":"Px00031010391","type":"CDM"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.0,"discounted_cash":308.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PATH CONSLTJ SURG CYTOLOGIC EXAM EACH ADDL SITE LAB","code_information":[{"code":"Px00031010396","type":"CDM"},{"code":"88334","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE LAB","code_information":[{"code":"Px00031010398","type":"CDM"},{"code":"88333","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":387.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE","code_information":[{"code":"Px00031010400","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ISH ANALYZE 100-300 CELLS","code_information":[{"code":"Px00031010403","type":"CDM"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":396.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL LAB","code_information":[{"code":"Px00031010407","type":"CDM"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL LAB","code_information":[{"code":"Px00031010409","type":"CDM"},{"code":"88274","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MICROSLIDE CONSULTATION W/ SLIDE PREP","code_information":[{"code":"Px00031010429","type":"CDM"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR CYTOGENETICS DNA PROBE EACH CDM","code_information":[{"code":"Px00031010443","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MPO FLOW","code_information":[{"code":"Px00031010456","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PAP SCREEN BY TECH","code_information":[{"code":"Px00031010465","type":"CDM"},{"code":"P3000","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION LAB","code_information":[{"code":"Px00031010468","type":"CDM"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC LAB","code_information":[{"code":"Px00031010473","type":"CDM"},{"code":"88331","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RECUT","code_information":[{"code":"Px00031010487","type":"CDM"},{"code":"88399","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IGH REARRANGE ABNORMAL CLONAL POP AMPLIFIED LAB","code_information":[{"code":"Px00031010490","type":"CDM"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":380.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPECIAL STAIN GROUP 1 MICROORGANISMS I&R LAB","code_information":[{"code":"Px00031010498","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT LAB","code_information":[{"code":"Px00031010500","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY LAB","code_information":[{"code":"Px00031010519","type":"CDM"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010520","type":"CDM"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010522","type":"CDM"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010524","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":301.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010531","type":"CDM"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB","code_information":[{"code":"Px00031010536","type":"CDM"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TDT FLOW","code_information":[{"code":"Px00031010541","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THIN PREP - NONS","code_information":[{"code":"Px00031010542","type":"CDM"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX LAB","code_information":[{"code":"Px00031010547","type":"CDM"},{"code":"88233","type":"HCPCS"}],"standard_charges":[{"gross_charge":1267.0,"discounted_cash":886.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE CULTURE AMNIOTIC FLUID","code_information":[{"code":"Px00031010549","type":"CDM"},{"code":"88235","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.0,"discounted_cash":556.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISS CUL NON-NEO DISORDERS LYMPHOCYTE","code_information":[{"code":"Px00031010554","type":"CDM"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":423.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE CULTURE SOLID TUMOR","code_information":[{"code":"Px00031010556","type":"CDM"},{"code":"88239","type":"HCPCS"}],"standard_charges":[{"gross_charge":1080.0,"discounted_cash":756.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TISSUE EXAM MOLECULAR STUDY","code_information":[{"code":"Px00031010557","type":"CDM"},{"code":"88387","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL LAB","code_information":[{"code":"Px00031010566","type":"CDM"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL","code_information":[{"code":"Px00031010568","type":"CDM"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ZAP 70-FLOW","code_information":[{"code":"Px00031010574","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHRMSM ALYS AMNIOTIC/VILLUS 15 CELL 1KARYOTYPE LAB","code_information":[{"code":"Px00031010576","type":"CDM"},{"code":"88267","type":"HCPCS"}],"standard_charges":[{"gross_charge":1033.0,"discounted_cash":723.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC B-CELL LYMPHOMA FISH DNA PROBE EACH","code_information":[{"code":"Px00031010584","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MOLECULAR CYTOGENETICS DNA PROBE EACH CDM","code_information":[{"code":"Px00031010585","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC B-CELL LYMPHOMA FISH 100-300 CELLS","code_information":[{"code":"Px00031010589","type":"CDM"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":396.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL LAB","code_information":[{"code":"Px00031010594","type":"CDM"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST LAB","code_information":[{"code":"Px00031010595","type":"CDM"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTOGEN M ARRAY COPY NO & SNP","code_information":[{"code":"Px00031010606","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":1544.0,"discounted_cash":1080.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IGH PCR","code_information":[{"code":"Px00031010613","type":"CDM"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTO BAL BRUSH OR WASH TC","code_information":[{"code":"Px00031010617","type":"CDM"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTO SMEAR CONCENT INTER ADDL","code_information":[{"code":"Px00031010618","type":"CDM"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTO FLUID URINE OR SPUTUM TC","code_information":[{"code":"Px00031010619","type":"CDM"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTO FNA TC","code_information":[{"code":"Px00031010620","type":"CDM"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTO CELL BLOCK TC","code_information":[{"code":"Px00031010621","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SURGICAL PATHOLOGY V TC","code_information":[{"code":"Px00031010622","type":"CDM"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPECIAL STAINS GRP I TC","code_information":[{"code":"Px00031010623","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPECIAL STAINS GRP II TC","code_information":[{"code":"Px00031010624","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE LAB","code_information":[{"code":"Px00031010625","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE LAB","code_information":[{"code":"Px00031010667","type":"CDM"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE LAB","code_information":[{"code":"Px00031010668","type":"CDM"},{"code":"88344","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN FISH LAB","code_information":[{"code":"Px00031010669","type":"CDM"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB","code_information":[{"code":"Px00031010673","type":"CDM"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB LAB","code_information":[{"code":"Px00031010674","type":"CDM"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNOFLUORESCENCE PR SPEC EA ADD SINGL ANTB STN LAB","code_information":[{"code":"Px00031010703","type":"CDM"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR","code_information":[{"code":"Px00031010799","type":"CDM"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 CDM","code_information":[{"code":"Px00031010801","type":"CDM"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTOGENOM CONST MICROARRAY LAB","code_information":[{"code":"Px00031010847","type":"CDM"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":893.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS LAB","code_information":[{"code":"Px00031010861","type":"CDM"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL","code_information":[{"code":"Px00031100005","type":"CDM"},{"code":"88120","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN","code_information":[{"code":"Px00031100010","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","code_information":[{"code":"Px00031100011","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV","code_information":[{"code":"Px00031100014","type":"CDM"},{"code":"88164","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","code_information":[{"code":"Px00031100021","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":109.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00031100048","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00031100049","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00031100050","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MN LAB","code_information":[{"code":"Px00031100055","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00031100056","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS LAB","code_information":[{"code":"Px00031100061","type":"CDM"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP CONCENTRATE SMEARS & INTERPRETATION","code_information":[{"code":"Px00031100066","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP CONCENTRATE SMEARS & INTERPRETATION","code_information":[{"code":"Px00031100067","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST","code_information":[{"code":"Px00031100068","type":"CDM"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA","code_information":[{"code":"Px00031100069","type":"CDM"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTP CONCENTRATION SMEARS AND INTERPRETATION LAB","code_information":[{"code":"Px00031110010","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTO EXAM PREP EA ADD SITE","code_information":[{"code":"Px00031110011","type":"CDM"},{"code":"88334","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYTO EXAM PREP INITIAL SITE","code_information":[{"code":"Px00031110012","type":"CDM"},{"code":"88333","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PAP SUREPATH DIAGNOSTIC","code_information":[{"code":"Px00031110030","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PAP-THIN PREP SCREENING","code_information":[{"code":"Px00031110033","type":"CDM"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VOLUME MEASUREMENT TIMED COLLECTION EACH CDM","code_information":[{"code":"Px00031900006","type":"CDM"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGE CDM","code_information":[{"code":"Px00031900011","type":"CDM"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":149.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN CDM","code_information":[{"code":"Px00031900012","type":"CDM"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANTIBODY WEST NILE VIRUS IGM CDM","code_information":[{"code":"Px00031900019","type":"CDM"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHEMILUMINESCENT ASSAY CDM","code_information":[{"code":"Px00031900048","type":"CDM"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM CDM","code_information":[{"code":"Px00031900056","type":"CDM"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE CDM","code_information":[{"code":"Px00031900068","type":"CDM"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI CDM","code_information":[{"code":"Px00031900069","type":"CDM"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":158.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF ALDOSTERONE CDM","code_information":[{"code":"Px00031900113","type":"CDM"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUAN EA (RL)","code_information":[{"code":"Px00031900136","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY IGA/IGD/IGG/IGM EACH (RL)","code_information":[{"code":"Px00031900137","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF SERUM ALBUMIN (RL)","code_information":[{"code":"Px00031900138","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OLIGOCLONAL BANDS (RL)","code_information":[{"code":"Px00031900139","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC JAK2 GENE ANALYSIS P.VAL617PHE VARIANT CDM","code_information":[{"code":"Px00031900176","type":"CDM"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NFCT AGENT DETECTION GI(RL)","code_information":[{"code":"Px00031900180","type":"CDM"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":334.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD CDM","code_information":[{"code":"Px00031900220","type":"CDM"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH CDM","code_information":[{"code":"Px00031900223","type":"CDM"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ALBUMIN SERUM PLASMA/WHOLE BLOOD CDM","code_information":[{"code":"Px00031900224","type":"CDM"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OLIGOCLONAL IMMUNE CDM","code_information":[{"code":"Px00031900225","type":"CDM"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":296.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN CDM","code_information":[{"code":"Px00031900226","type":"CDM"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MCG DNA PROBE EA (RL)","code_information":[{"code":"Px00031900289","type":"CDM"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MCG IP SITU 25-99 CELLS (RL)","code_information":[{"code":"Px00031900290","type":"CDM"},{"code":"88274","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR EYE FOR FOREIGN BODY","code_information":[{"code":"Px00032010003","type":"CDM"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR TOE(S) MIN 2 VIEWS","code_information":[{"code":"Px00032010004","type":"CDM"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR MANDIBLE 1-3 VIEWS","code_information":[{"code":"Px00032010006","type":"CDM"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":351.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR MANDIBLE MIN 4 VIEWS","code_information":[{"code":"Px00032010007","type":"CDM"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.0,"discounted_cash":627.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR MASTOIDS UNI LT/3 VIEWS","code_information":[{"code":"Px00032010008","type":"CDM"},{"code":"70120","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":411.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR MASTOIDS 3/PLUS VIEWS","code_information":[{"code":"Px00032010009","type":"CDM"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.0,"discounted_cash":645.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR FACIAL BONES LT/3 VIEWS","code_information":[{"code":"Px00032010011","type":"CDM"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":541.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR FACIAL BONES MIN 3 VIEWS","code_information":[{"code":"Px00032010012","type":"CDM"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":725.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR NASAL BONES MIN 3 VIEWS","code_information":[{"code":"Px00032010014","type":"CDM"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":416.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR OPTIC FORAMINA","code_information":[{"code":"Px00032010016","type":"CDM"},{"code":"70190","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":375.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ORBITS MIN 4 VIEWS","code_information":[{"code":"Px00032010017","type":"CDM"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":569.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SINUSES PARANASAL LT/3 VIEWS","code_information":[{"code":"Px00032010018","type":"CDM"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":343.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SINUSES PARANASAL MIN 3 VIEWS","code_information":[{"code":"Px00032010020","type":"CDM"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":789.0,"discounted_cash":552.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SELLA TURCICA","code_information":[{"code":"Px00032010021","type":"CDM"},{"code":"70240","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":375.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SKULL 1-3 VIEWS","code_information":[{"code":"Px00032010022","type":"CDM"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":537.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SKULL MIN 4 VIEWS","code_information":[{"code":"Px00032010023","type":"CDM"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":652.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR JAW JOINT","code_information":[{"code":"Px00032010027","type":"CDM"},{"code":"70328","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR JAW TEMPOROMANDIBULAR JOINT BIL","code_information":[{"code":"Px00032010028","type":"CDM"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 1 VIEW","code_information":[{"code":"Px00032010029","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR NECK SOFT TISSUE","code_information":[{"code":"Px00032010031","type":"CDM"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR BONE LENGTH STUDY","code_information":[{"code":"Px00032010039","type":"CDM"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY LIMITED","code_information":[{"code":"Px00032010040","type":"CDM"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":459.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ESOPHAGUS W CONTRAST","code_information":[{"code":"Px00032010041","type":"CDM"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR RIBS UNI 2 VIEWS","code_information":[{"code":"Px00032010045","type":"CDM"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.0,"discounted_cash":464.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR RIBS/CHEST UNI MIN 3 VIEWS","code_information":[{"code":"Px00032010046","type":"CDM"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":584.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR RIBS BIL 3 VIEWS","code_information":[{"code":"Px00032010048","type":"CDM"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.0,"discounted_cash":762.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR RIBS/CHEST BILAT","code_information":[{"code":"Px00032010049","type":"CDM"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.0,"discounted_cash":762.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR STERNUM MIN 2 VIEWS","code_information":[{"code":"Px00032010050","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR STERNOCLAVICULAR JOINTS MIN 3 VIEWS","code_information":[{"code":"Px00032010051","type":"CDM"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":471.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SPINE 1 VIEW ANY LEVEL","code_information":[{"code":"Px00032010053","type":"CDM"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":374.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SPINE CERVICAL 2 OR 3 VIEWS","code_information":[{"code":"Px00032010055","type":"CDM"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":405.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SPINE CERVICAL 4 OR 5 VIEWS","code_information":[{"code":"Px00032010056","type":"CDM"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":648.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR CERVICAL SPINE 6 OR MORE VIEWS","code_information":[{"code":"Px00032010057","type":"CDM"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":1379.0,"discounted_cash":965.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC 2 VIEWS","code_information":[{"code":"Px00032010059","type":"CDM"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":541.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC 3 VIEWS","code_information":[{"code":"Px00032010060","type":"CDM"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.0,"discounted_cash":564.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACIC MIN 4 VIEWS","code_information":[{"code":"Px00032010061","type":"CDM"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.0,"discounted_cash":620.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SPINE THORACOLUMBAR MIN 2 VIEWS","code_information":[{"code":"Px00032010062","type":"CDM"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":580.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS","code_information":[{"code":"Px00032010065","type":"CDM"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":454.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPINE LUMBOSACRAL MIN 4 VIEWS","code_information":[{"code":"Px00032010066","type":"CDM"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SPINE LUMBOSACRAL INC BENDING MIN 6 VIEWS","code_information":[{"code":"Px00032010067","type":"CDM"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":1067.0,"discounted_cash":746.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SPINE 2-3 VIEWS LUMBAR BEND ONLY","code_information":[{"code":"Px00032010068","type":"CDM"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR PELVIS 1-2 VIEWS NO HIP VIEWS","code_information":[{"code":"Px00032010069","type":"CDM"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":343.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR PELVIS MIN 3 VIEWS NO HIP VIEWS","code_information":[{"code":"Px00032010072","type":"CDM"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":411.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SACROILIAC JOINTS 1-2 VIEWS","code_information":[{"code":"Px00032010073","type":"CDM"},{"code":"72200","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SACROILIAC JOINTS 3/PLUS VIEWS","code_information":[{"code":"Px00032010074","type":"CDM"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":411.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR TAILBONE MIN 2 VIEWS","code_information":[{"code":"Px00032010075","type":"CDM"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":429.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR CLAVICLE  COMPLETE","code_information":[{"code":"Px00032010085","type":"CDM"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.0,"discounted_cash":363.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW LIMITED","code_information":[{"code":"Px00032010086","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":356.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR HEEL MIN 2 VIEWS","code_information":[{"code":"Px00032010088","type":"CDM"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":314.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SCAPULA COMPLETE","code_information":[{"code":"Px00032010089","type":"CDM"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR FOOT MIN 3 VIEWS","code_information":[{"code":"Px00032010091","type":"CDM"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":394.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER 1 VIEW","code_information":[{"code":"Px00032010092","type":"CDM"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":295.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER A-C JOINTS BIL","code_information":[{"code":"Px00032010099","type":"CDM"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.0,"discounted_cash":485.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR HUMERUS 1 VIEW","code_information":[{"code":"Px00032010101","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR HUMERUS MIN 2 VIEWS","code_information":[{"code":"Px00032010102","type":"CDM"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW 2 VIEWS","code_information":[{"code":"Px00032010105","type":"CDM"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":356.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ELBOW COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010106","type":"CDM"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 2 VIEWS","code_information":[{"code":"Px00032010107","type":"CDM"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR FOOT 2 VIEWS","code_information":[{"code":"Px00032010110","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":288.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR FOREARM 2 VIEWS","code_information":[{"code":"Px00032010112","type":"CDM"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":361.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ARM INFANT MIN 2 VIEWS","code_information":[{"code":"Px00032010115","type":"CDM"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR WRIST 1 VIEW","code_information":[{"code":"Px00032010117","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR WRIST 2 VIEWS","code_information":[{"code":"Px00032010118","type":"CDM"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR WRIST COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010119","type":"CDM"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":403.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR HAND 1 VIEW","code_information":[{"code":"Px00032010125","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":384.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR HAND 2 VIEWS","code_information":[{"code":"Px00032010127","type":"CDM"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":384.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR HAND MIN 3 VIEWS","code_information":[{"code":"Px00032010129","type":"CDM"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":438.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR FINGERS(S) MIN 2 VIEWS","code_information":[{"code":"Px00032010131","type":"CDM"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN 3/PLUS VIEWS","code_information":[{"code":"Px00032010135","type":"CDM"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 1-2 VIEWS","code_information":[{"code":"Px00032010149","type":"CDM"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":328.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 3 VIEWS","code_information":[{"code":"Px00032010152","type":"CDM"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":431.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR KNEE 4/PLUS VIEWS","code_information":[{"code":"Px00032010154","type":"CDM"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR KNEES STANDING BILAT","code_information":[{"code":"Px00032010156","type":"CDM"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":382.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR LOWER LEG 2 VIEWS","code_information":[{"code":"Px00032010159","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR LEG INFANT MIN 2 VIEWS","code_information":[{"code":"Px00032010161","type":"CDM"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE 2 VIEWS","code_information":[{"code":"Px00032010163","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":384.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE COMPLETE MIN 3 VIEWS","code_information":[{"code":"Px00032010165","type":"CDM"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":405.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN COMPLETE SERIES","code_information":[{"code":"Px00032010175","type":"CDM"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SMALL INTESTINE W CONTRAST","code_information":[{"code":"Px00032010187","type":"CDM"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":487.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ABDOMEN PORTABLE 1 VIEW","code_information":[{"code":"Px00032010190","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR BILE DUCTS/PANCREAS INTRAOP","code_information":[{"code":"Px00032010196","type":"CDM"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":460.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUOROSCOPY UP TO 1 HR","code_information":[{"code":"Px00032010318","type":"CDM"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR PEDIATRIC FOREIGN BODY 1 VIEW","code_information":[{"code":"Px00032010320","type":"CDM"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":296.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT","code_information":[{"code":"Px00032010330","type":"CDM"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":408.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS","code_information":[{"code":"Px00032010337","type":"CDM"},{"code":"77071","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR BONE AGE STUDY","code_information":[{"code":"Px00032010338","type":"CDM"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY COMPLETE","code_information":[{"code":"Px00032010341","type":"CDM"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1488.0,"discounted_cash":1041.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR BONE SURVEY INFANT","code_information":[{"code":"Px00032010342","type":"CDM"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":1642.0,"discounted_cash":1149.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR JOINT SURVEY 1 VIEW","code_information":[{"code":"Px00032010343","type":"CDM"},{"code":"77077","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":399.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RADIOLOGY UNLISTED PROCEDURE","code_information":[{"code":"Px00032010465","type":"CDM"},{"code":"76499","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":702.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR SHOULDER COMPLETE MIN 2 VIEWS","code_information":[{"code":"Px00032010481","type":"CDM"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":420.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR FOREARM 1 VIEW","code_information":[{"code":"Px00032010483","type":"CDM"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":361.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR LOWER LEG LIMITED","code_information":[{"code":"Px00032010499","type":"CDM"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ANKLE 1 VIEW","code_information":[{"code":"Px00032010503","type":"CDM"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":384.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR FOOT 1 VIEW","code_information":[{"code":"Px00032010505","type":"CDM"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":288.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR STERNUM 1 VIEW","code_information":[{"code":"Px00032010600","type":"CDM"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE 1 VIEW","code_information":[{"code":"Px00032010604","type":"CDM"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.0,"discounted_cash":483.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE 2 OR 3 VIEWS","code_information":[{"code":"Px00032010605","type":"CDM"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":560.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE 4 OR 5 VIEWS","code_information":[{"code":"Px00032010606","type":"CDM"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.0,"discounted_cash":639.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR ENTIRE SPINE MIN 6 VIEWS","code_information":[{"code":"Px00032010607","type":"CDM"},{"code":"72084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1134.0,"discounted_cash":793.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR HIPS UNI W PELVIS WHEN PERFORMED 1 VIEW","code_information":[{"code":"Px00032010608","type":"CDM"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR HIPS UNI W PELVIS WHEN PERFORMED 2-3 VIEWS","code_information":[{"code":"Px00032010609","type":"CDM"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":439.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR HIPS UNI W PELVIS WHEN PERFORMED MIN 4 VIEWS","code_information":[{"code":"Px00032010610","type":"CDM"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":439.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR HIPS BIL W PELVIS WHEN PERFORMED 2 VIEWS","code_information":[{"code":"Px00032010611","type":"CDM"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":584.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR HIPS BIL W PELVIS WHEN PERFORMED 3-4 VIEWS","code_information":[{"code":"Px00032010612","type":"CDM"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":584.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR HIPS BIL W PELVIS WHEN PERFORMED MIN 5 VIEWS","code_information":[{"code":"Px00032010613","type":"CDM"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":584.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR FEMUR 1 VIEW","code_information":[{"code":"Px00032010614","type":"CDM"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.0,"discounted_cash":464.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR FEMUR MIN 2 VIEWS","code_information":[{"code":"Px00032010615","type":"CDM"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.0,"discounted_cash":464.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 1 VIEW","code_information":[{"code":"Px00032410014","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 2 VIEWS","code_information":[{"code":"Px00032410015","type":"CDM"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 3 VIEWS","code_information":[{"code":"Px00032410016","type":"CDM"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":449.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR CHEST 4/PLUS VIEWS","code_information":[{"code":"Px00032410017","type":"CDM"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XR CHEST PORTABLE 1 VIEW","code_information":[{"code":"Px00032410018","type":"CDM"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":254.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV PUSH INITIAL OR SINGLE DRUG CDM","code_information":[{"code":"Px00033110007","type":"CDM"},{"code":"96409","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION INITIAL HR CDM","code_information":[{"code":"Px00033510003","type":"CDM"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.0,"discounted_cash":562.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHEMO IV INFUSION ADDL HR CDM","code_information":[{"code":"Px00033510004","type":"CDM"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL W/O DYE LIMITED","code_information":[{"code":"Px00035010003","type":"CDM"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1522.0,"discounted_cash":1065.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL WO & W CONTRAST","code_information":[{"code":"Px00035010006","type":"CDM"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":1953.0,"discounted_cash":1367.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT SOFT TISSUE NECK WO CONTRAST","code_information":[{"code":"Px00035010007","type":"CDM"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1338.0,"discounted_cash":936.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT SOFT TISSUE NECK W CONTRAST","code_information":[{"code":"Px00035010008","type":"CDM"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1791.0,"discounted_cash":1253.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT SOFT TISSUE NECK W & W/O CONTRAST","code_information":[{"code":"Px00035010009","type":"CDM"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":2015.0,"discounted_cash":1410.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY NECK W CONTRAST","code_information":[{"code":"Px00035010010","type":"CDM"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":2379.0,"discounted_cash":1665.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT THORAX WO CONTRAST","code_information":[{"code":"Px00035010011","type":"CDM"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1590.0,"discounted_cash":1113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W/O DYE LUNG SCREENING","code_information":[{"code":"Px00035010012","type":"CDM"}],"standard_charges":[{"gross_charge":1878.0,"discounted_cash":1314.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY CHEST","code_information":[{"code":"Px00035010013","type":"CDM"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":3829.0,"discounted_cash":2680.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT LWR EXTREMITY WO & W CONTRAST","code_information":[{"code":"Px00035010018","type":"CDM"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":2994.0,"discounted_cash":2095.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ANGIO LWR EXTR W/O&W/DYE","code_information":[{"code":"Px00035010020","type":"CDM"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":3596.0,"discounted_cash":2517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CTA ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035010023","type":"CDM"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":3668.0,"discounted_cash":2567.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ABD & PELVIS WO CONTRAST","code_information":[{"code":"Px00035010024","type":"CDM"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":3624.0,"discounted_cash":2536.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN & PELVIS W  CONTRAST","code_information":[{"code":"Px00035010025","type":"CDM"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":4844.0,"discounted_cash":3390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CCTA HEART ARTERIES/GRAFTS W/3D IMAGE W/ CONTRAST","code_information":[{"code":"Px00035010030","type":"CDM"},{"code":"75574","type":"HCPCS"}],"standard_charges":[{"gross_charge":1447.0,"discounted_cash":1012.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CTA AORTA BIL ILIOFEM W & W/O CONTRAST","code_information":[{"code":"Px00035010031","type":"CDM"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":4015.0,"discounted_cash":2810.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT SCAN FOLLOW-UP STUDY LIMITED","code_information":[{"code":"Px00035010034","type":"CDM"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":497.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CTA ABDOMEN PELVIS","code_information":[{"code":"Px00035010072","type":"CDM"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":6170.0,"discounted_cash":4319.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN WO CONTRAST","code_information":[{"code":"Px00035110002","type":"CDM"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1476.0,"discounted_cash":1033.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN W CONTRAST","code_information":[{"code":"Px00035110007","type":"CDM"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT HEAD/BRAIN W & W/O CONTRAST","code_information":[{"code":"Px00035110012","type":"CDM"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2116.0,"discounted_cash":1481.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ORBIT/EAR/FOSSA WO CONTRAST","code_information":[{"code":"Px00035110014","type":"CDM"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1520.0,"discounted_cash":1064.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ORBIT/EAR/FOSSA W CONTRAST","code_information":[{"code":"Px00035110017","type":"CDM"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":1986.0,"discounted_cash":1390.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ORBIT/EAR/FOSSA W & W/O CONTRAST","code_information":[{"code":"Px00035110019","type":"CDM"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":2099.0,"discounted_cash":1469.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL WO CONTRAST","code_information":[{"code":"Px00035110022","type":"CDM"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1522.0,"discounted_cash":1065.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT MAXILLOFACIAL W CONTRAST","code_information":[{"code":"Px00035110030","type":"CDM"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":1874.0,"discounted_cash":1311.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ANGIOGRAPHY HEAD W CONTRAST","code_information":[{"code":"Px00035110032","type":"CDM"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":2319.0,"discounted_cash":1623.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM","code_information":[{"code":"Px00035200001","type":"CDM"},{"code":"71271","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W CONTRAST","code_information":[{"code":"Px00035210003","type":"CDM"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1840.0,"discounted_cash":1288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W & W/O CONTRAST","code_information":[{"code":"Px00035210006","type":"CDM"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2852.0,"discounted_cash":1996.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT NECK SPINE WO CONTRAST","code_information":[{"code":"Px00035210008","type":"CDM"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":1583.0,"discounted_cash":1108.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT NECK SPINE W/DYE","code_information":[{"code":"Px00035210009","type":"CDM"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":1297.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT NECK SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210010","type":"CDM"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":1982.0,"discounted_cash":1387.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE WO CONTRAST","code_information":[{"code":"Px00035210011","type":"CDM"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE W CONTRAST","code_information":[{"code":"Px00035210012","type":"CDM"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":2077.0,"discounted_cash":1453.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT CHEST SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210013","type":"CDM"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":2487.0,"discounted_cash":1740.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE WO CONTRAST","code_information":[{"code":"Px00035210014","type":"CDM"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":1582.0,"discounted_cash":1107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE W CONTRAST","code_information":[{"code":"Px00035210015","type":"CDM"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":1243.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT LUMBAR SPINE W & W/O CONTRAST","code_information":[{"code":"Px00035210016","type":"CDM"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":2487.0,"discounted_cash":1740.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CTA PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210017","type":"CDM"},{"code":"72191","type":"HCPCS"}],"standard_charges":[{"gross_charge":3551.0,"discounted_cash":2485.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT PELVIS WO CONTRAST","code_information":[{"code":"Px00035210018","type":"CDM"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":1525.0,"discounted_cash":1067.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT PELVIS W CONTRAST","code_information":[{"code":"Px00035210020","type":"CDM"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":1757.0,"discounted_cash":1229.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210024","type":"CDM"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":2145.0,"discounted_cash":1501.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT UPPER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210029","type":"CDM"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1743.0,"discounted_cash":1220.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT LOWER EXTREMITY WO CONTRAST","code_information":[{"code":"Px00035210030","type":"CDM"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1479.0,"discounted_cash":1035.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT UPPER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210031","type":"CDM"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.0,"discounted_cash":1262.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT UPPR EXTREMITY W & W/O CONTRAST","code_information":[{"code":"Px00035210034","type":"CDM"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":2609.0,"discounted_cash":1826.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ANGIO UPR EXTRM W & W/O CONTRAST","code_information":[{"code":"Px00035210037","type":"CDM"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":2236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN WO CONTRAST","code_information":[{"code":"Px00035210038","type":"CDM"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1849.0,"discounted_cash":1294.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT LOWER EXTREMITY W CONTRAST","code_information":[{"code":"Px00035210040","type":"CDM"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":1812.0,"discounted_cash":1268.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN W CONTRAST","code_information":[{"code":"Px00035210046","type":"CDM"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2204.0,"discounted_cash":1542.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN W & W/O CONTRAST","code_information":[{"code":"Px00035210047","type":"CDM"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":2674.0,"discounted_cash":1871.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT ABDOMEN & PELVIS W & W/O CONTRAST","code_information":[{"code":"Px00035210054","type":"CDM"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":5273.0,"discounted_cash":3691.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CT THORAX W/O DYE F/U LUNG SCREENING","code_information":[{"code":"Px00035210105","type":"CDM"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1590.0,"discounted_cash":1113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ROBOTIC SURGICAL SYSTEM CDM","code_information":[{"code":"Px00036000019","type":"CDM"},{"code":"S2900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RT BRONCH LEVEL 1 CDM","code_information":[{"code":"Px00036000021","type":"CDM"}],"standard_charges":[{"gross_charge":2358.0,"discounted_cash":1650.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 2 CDM","code_information":[{"code":"Px00036000022","type":"CDM"}],"standard_charges":[{"gross_charge":2946.0,"discounted_cash":2062.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 3 CDM","code_information":[{"code":"Px00036000023","type":"CDM"}],"standard_charges":[{"gross_charge":4106.0,"discounted_cash":2874.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 4 CDM","code_information":[{"code":"Px00036000024","type":"CDM"}],"standard_charges":[{"gross_charge":5335.0,"discounted_cash":3734.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 5 CDM","code_information":[{"code":"Px00036000025","type":"CDM"}],"standard_charges":[{"gross_charge":5870.0,"discounted_cash":4109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC RT BRONCH LEVEL 6 CDM","code_information":[{"code":"Px00036000026","type":"CDM"}],"standard_charges":[{"gross_charge":6308.0,"discounted_cash":4415.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 1","code_information":[{"code":"Px00036010001","type":"CDM"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 2","code_information":[{"code":"Px00036010002","type":"CDM"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 3","code_information":[{"code":"Px00036010003","type":"CDM"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 4","code_information":[{"code":"Px00036010004","type":"CDM"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 5","code_information":[{"code":"Px00036010005","type":"CDM"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC BEDSIDE BRONCHOSCOPY W/BIOPSY(S)","code_information":[{"code":"Px00036010080","type":"CDM"},{"code":"31625","type":"HCPCS"}],"standard_charges":[{"gross_charge":2857.0,"discounted_cash":1999.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BRONCHOSCOPY/NEEDLE BX EACH","code_information":[{"code":"Px00036010082","type":"CDM"},{"code":"31629","type":"HCPCS"}],"standard_charges":[{"gross_charge":2857.0,"discounted_cash":1999.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST","code_information":[{"code":"Px00036010090","type":"CDM"},{"code":"31645","type":"HCPCS"}],"standard_charges":[{"gross_charge":3986.0,"discounted_cash":2790.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","code_information":[{"code":"Px00036010110","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRAINAGE OF BREAST LESION","code_information":[{"code":"Px00036010111","type":"CDM"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJ TENDON ORIGIN/INSERTION","code_information":[{"code":"Px00036010129","type":"CDM"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE","code_information":[{"code":"Px00036010130","type":"CDM"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE","code_information":[{"code":"Px00036010131","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASPIRATE/INJ GANGLION CYST","code_information":[{"code":"Px00036010132","type":"CDM"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 1ST 30 MINS","code_information":[{"code":"Px00036010146","type":"CDM"}],"standard_charges":[{"gross_charge":3937.0,"discounted_cash":2755.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 1ST 30 MINS","code_information":[{"code":"Px00036010147","type":"CDM"}],"standard_charges":[{"gross_charge":3937.0,"discounted_cash":2755.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 1ST 30 MINS","code_information":[{"code":"Px00036010148","type":"CDM"}],"standard_charges":[{"gross_charge":3937.0,"discounted_cash":2755.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 1ST 30 MINS","code_information":[{"code":"Px00036010149","type":"CDM"}],"standard_charges":[{"gross_charge":3937.0,"discounted_cash":2755.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 1ST 30 MINS","code_information":[{"code":"Px00036010150","type":"CDM"}],"standard_charges":[{"gross_charge":3937.0,"discounted_cash":2755.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 1ST 30 MINS","code_information":[{"code":"Px00036010151","type":"CDM"}],"standard_charges":[{"gross_charge":3937.0,"discounted_cash":2755.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 1ST 30 MINS","code_information":[{"code":"Px00036010152","type":"CDM"}],"standard_charges":[{"gross_charge":3937.0,"discounted_cash":2755.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 8 1ST 30 MINS","code_information":[{"code":"Px00036010153","type":"CDM"}],"standard_charges":[{"gross_charge":3937.0,"discounted_cash":2755.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 1 PER MIN","code_information":[{"code":"Px00036010212","type":"CDM"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 2 PER MIN","code_information":[{"code":"Px00036010214","type":"CDM"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 3 PER MIN","code_information":[{"code":"Px00036010216","type":"CDM"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 4 PER MIN","code_information":[{"code":"Px00036010218","type":"CDM"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 5 PER MIN","code_information":[{"code":"Px00036010220","type":"CDM"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 6 PER MIN","code_information":[{"code":"Px00036010222","type":"CDM"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 7 PER MIN","code_information":[{"code":"Px00036010224","type":"CDM"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OPERATING ROOM SERVICES LEVEL 8 PER MIN","code_information":[{"code":"Px00036010226","type":"CDM"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF PROSTATE","code_information":[{"code":"Px00036010343","type":"CDM"},{"code":"55700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1635.0,"discounted_cash":1144.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PAIN ROOM SERVICES LEVEL 6","code_information":[{"code":"Px00036010371","type":"CDM"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC BONE MARROW BIOPSY","code_information":[{"code":"Px00036010406","type":"CDM"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":318.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX CDM","code_information":[{"code":"Px00036010408","type":"CDM"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":3986.0,"discounted_cash":2790.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY DIAGNOSTIC","code_information":[{"code":"Px00036010413","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC YAG LASAR PROCEDURE","code_information":[{"code":"Px00036010493","type":"CDM"}],"standard_charges":[{"gross_charge":4048.0,"discounted_cash":2833.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AMNIOCENTESIS DIAGNOSTIC CDM","code_information":[{"code":"Px00036010901","type":"CDM"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":200.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NEWBORN STABILIZATION AT DELIVERY - RESP THER CDM","code_information":[{"code":"Px00036010965","type":"CDM"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":459.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INSERTION PICC W/O IMG GDN 5 YR/>","code_information":[{"code":"Px00036010969","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE CDM","code_information":[{"code":"Px00036012016","type":"CDM"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":1316.0,"discounted_cash":921.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE CDM","code_information":[{"code":"Px00036100013","type":"CDM"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":2375.0,"discounted_cash":1662.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG CDM","code_information":[{"code":"Px00036100080","type":"CDM"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","code_information":[{"code":"Px00036110005","type":"CDM"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE","code_information":[{"code":"Px00036110071","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJECT EPIDURAL PATCH","code_information":[{"code":"Px00036110072","type":"CDM"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BONE MARROW ASPIRATION","code_information":[{"code":"Px00036110101","type":"CDM"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC REPLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"Px00036110115","type":"CDM"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":1765.0,"discounted_cash":1235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INSERTION OF HEART ELECTRODE 33210","code_information":[{"code":"Px00036110172","type":"CDM"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":10911.0,"discounted_cash":7637.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INSERT PICC WO PORT PUMP LT 5 YR W IMG","code_information":[{"code":"Px00036110259","type":"CDM"},{"code":"36572","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.0,"discounted_cash":865.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INSERTION PICC W/RS&I 5 YR/>","code_information":[{"code":"Px00036110260","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3181.0,"discounted_cash":2226.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INSERT NON TUNNEL CV CATH GTE 5 YR","code_information":[{"code":"Px00036110418","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":1169.0,"discounted_cash":818.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INSERTION PICC WO IMG GDN GTE 5 YR","code_information":[{"code":"Px00036110432","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC REPLACE NON TUNNEL CVAD CATH","code_information":[{"code":"Px00036110440","type":"CDM"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":3181.0,"discounted_cash":2226.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLETE REPLACEMENT PICC RS&I","code_information":[{"code":"Px00036110443","type":"CDM"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":3181.0,"discounted_cash":2226.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED CDM","code_information":[{"code":"Px00036110446","type":"CDM"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":5557.0,"discounted_cash":3889.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PERQ PRCRD DRG GTE 6YR W/O CONGENITAL CAR ANOMALY CDM","code_information":[{"code":"Px00036110459","type":"CDM"},{"code":"33017","type":"HCPCS"}],"standard_charges":[{"gross_charge":5557.0,"discounted_cash":3889.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY CDM","code_information":[{"code":"Px00036110461","type":"CDM"},{"code":"33018","type":"HCPCS"}],"standard_charges":[{"gross_charge":5557.0,"discounted_cash":3889.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT CDM","code_information":[{"code":"Px00036110462","type":"CDM"},{"code":"33019","type":"HCPCS"}],"standard_charges":[{"gross_charge":5557.0,"discounted_cash":3889.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROMBOLYTIC THERAPY STROKE","code_information":[{"code":"Px00036110481","type":"CDM"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":355.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APPLICATION OF UNABOOT BIL","code_information":[{"code":"Px00036110555","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US","code_information":[{"code":"Px00036110562","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPINE SURGERY PROCEDURE","code_information":[{"code":"Px00036110571","type":"CDM"},{"code":"22899","type":"HCPCS"}],"standard_charges":[{"gross_charge":6650.0,"discounted_cash":4655.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST","code_information":[{"code":"Px00036110602","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMPLEX DRAINAGE WOUND","code_information":[{"code":"Px00036110603","type":"CDM"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":2621.0,"discounted_cash":1834.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INSERT EMERGENCY AIRWAY CDM","code_information":[{"code":"Px00036110619","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TUBE THORACOSTOMY INCLUDES WATER SEAL","code_information":[{"code":"Px00036110622","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.0,"discounted_cash":488.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC REPAIR BLOOD VESSEL LESION","code_information":[{"code":"Px00036110629","type":"CDM"},{"code":"35226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.0,"discounted_cash":1192.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THROAT SURGERY PROCEDURE","code_information":[{"code":"Px00036110644","type":"CDM"},{"code":"42999","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":400.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM","code_information":[{"code":"Px00036110646","type":"CDM"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRAIN BLADDER W/CATH INSERTION","code_information":[{"code":"Px00036110683","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":2606.0,"discounted_cash":1824.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYSTOSTOMY TUBE CHANGE","code_information":[{"code":"Px00036110687","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHANGE OF BLADDER TUBE","code_information":[{"code":"Px00036110688","type":"CDM"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX","code_information":[{"code":"Px00036110696","type":"CDM"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC N BLOCK INJ FEM SINGLE","code_information":[{"code":"Px00036110717","type":"CDM"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC N BLOCK OTHER PERIPHERAL","code_information":[{"code":"Px00036110718","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS","code_information":[{"code":"Px00036110783","type":"CDM"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CENTRAL LINE INSERTION","code_information":[{"code":"Px00036110804","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":1169.0,"discounted_cash":818.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL","code_information":[{"code":"Px00036111071","type":"CDM"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":952.0,"discounted_cash":666.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DELIVERY PLACENTA SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00036111084","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING","code_information":[{"code":"Px00036111124","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING","code_information":[{"code":"Px00036111126","type":"CDM"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":479.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","code_information":[{"code":"Px00036111127","type":"CDM"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.0,"discounted_cash":488.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJ JOINT/BURSA SMALL W/US","code_information":[{"code":"Px00036111216","type":"CDM"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":323.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJ JOINT/BURSA INTERMEDIATE W/US","code_information":[{"code":"Px00036111217","type":"CDM"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DRAIN/INJ JOINT/BURSA MAJOR W/US","code_information":[{"code":"Px00036111218","type":"CDM"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.0,"discounted_cash":994.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PERQ CERVICOTHORACIC INJECT","code_information":[{"code":"Px00036111222","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PERQ LUMBOSACRAL INJECTION","code_information":[{"code":"Px00036111223","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VERTEBROPLASTY ADDL INJECT","code_information":[{"code":"Px00036111224","type":"CDM"},{"code":"22512","type":"HCPCS"}],"standard_charges":[{"gross_charge":3541.0,"discounted_cash":2478.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WOUND NEG PRESSURE TX USING NON-DME LTE 50 SQCM","code_information":[{"code":"Px00036111242","type":"CDM"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WOUND NEG PRESSURE TX USING NON-DME GT 50 SQCM","code_information":[{"code":"Px00036111243","type":"CDM"},{"code":"97608","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PELVIS/HIP JOINT SURGERY","code_information":[{"code":"Px00036112010","type":"CDM"},{"code":"27299","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ATTEMPT PICC W/O IMG GDN 5 YR/>","code_information":[{"code":"Px00036112059","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":459.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYSTOSCOPY PROCEDURE","code_information":[{"code":"Px00036113018","type":"CDM"}],"standard_charges":[{"gross_charge":1412.0,"discounted_cash":988.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WOUND NEG PRESSURE TX USING DME EQUIP LTE 50SQ CM","code_information":[{"code":"Px00036113066","type":"CDM"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WOUND NEG PRESSURE TX USING DME EQUIP GT 50SQ CM","code_information":[{"code":"Px00036113067","type":"CDM"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":222.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJ INTERLAMINAR CRV/THRC W/O IMG","code_information":[{"code":"Px00036114046","type":"CDM"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S  W/IMG","code_information":[{"code":"Px00036114048","type":"CDM"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJ INTRALAMINAR CRV/THRC W/O IMG","code_information":[{"code":"Px00036114049","type":"CDM"},{"code":"62324","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJ CATH PLCMENT CONT INFUS OR BOLUS C/T W/IMAG","code_information":[{"code":"Px00036114050","type":"CDM"},{"code":"62325","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":805.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJ INTERLAMINAR LMBR/SAC W/O IMG","code_information":[{"code":"Px00036114051","type":"CDM"},{"code":"62326","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":805.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJ PLACE CATH EPI CONT INF OR  BOLUS L/S W/IMG","code_information":[{"code":"Px00036114052","type":"CDM"},{"code":"62327","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":805.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENDOSC DCMP 1 SPACE LUM","code_information":[{"code":"Px00036114053","type":"CDM"},{"code":"62380","type":"HCPCS"}],"standard_charges":[{"gross_charge":15128.0,"discounted_cash":10589.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","code_information":[{"code":"Px00036114054","type":"CDM"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG","code_information":[{"code":"Px00036114055","type":"CDM"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC VNPNXR 3 YEARS/> PHYS/QHP SKILL- MIDLINE CATHETER INSERTION > 3 YR","code_information":[{"code":"Px00036155555","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":1148.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS LT/5YRS","code_information":[{"code":"Px00037010151","type":"CDM"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS GT/5YRS","code_information":[{"code":"Px00037010152","type":"CDM"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","code_information":[{"code":"Px00037010153","type":"CDM"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS LT/5YRS","code_information":[{"code":"Px00037010154","type":"CDM"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MOD SED OTHER PHYS/QHP INITIAL 15MINS GT/5YRS","code_information":[{"code":"Px00037010155","type":"CDM"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","code_information":[{"code":"Px00037010156","type":"CDM"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT","code_information":[{"code":"Px00039010002","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WHOLE BLOOD FOR TRANSFUSION","code_information":[{"code":"Px00039010010","type":"CDM"},{"code":"P9010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1510.0,"discounted_cash":1057.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED","code_information":[{"code":"Px00039010015","type":"CDM"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FRESH FROZEN PLASMA EA UNIT FRZ W/IN 8 HR","code_information":[{"code":"Px00039010017","type":"CDM"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELETS EACH UNIT","code_information":[{"code":"Px00039010018","type":"CDM"},{"code":"P9019","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RED BLOOD CELLS UNIT","code_information":[{"code":"Px00039010022","type":"CDM"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WASHED RED BLOOD CELLS UNIT","code_information":[{"code":"Px00039010024","type":"CDM"},{"code":"P9022","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":303.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELETS IRRADIATED","code_information":[{"code":"Px00039010028","type":"CDM"},{"code":"P9032","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS","code_information":[{"code":"Px00039010030","type":"CDM"},{"code":"P9034","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":551.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDUCED","code_information":[{"code":"Px00039010031","type":"CDM"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":508.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS IRRADIATED","code_information":[{"code":"Px00039010032","type":"CDM"},{"code":"P9036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1830.0,"discounted_cash":1281.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELET PHERESIS LEUKOREDU IRRAD","code_information":[{"code":"Px00039010033","type":"CDM"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":1510.0,"discounted_cash":1057.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RBC IRRADIATED","code_information":[{"code":"Px00039010034","type":"CDM"},{"code":"P9038","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RBC WASHED LEUKOREDUC IRRAD","code_information":[{"code":"Px00039010043","type":"CDM"},{"code":"P9057","type":"HCPCS"}],"standard_charges":[{"gross_charge":2886.0,"discounted_cash":2020.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FRESH FROZEN PLASMA FRZ BETWEEN 8-24HOUR","code_information":[{"code":"Px00039010045","type":"CDM"},{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FRESH FROZEN PLASMA DONOR RETESTED","code_information":[{"code":"Px00039010046","type":"CDM"},{"code":"P9060","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELET APH LEUKO IRR EA UNIT","code_information":[{"code":"Px00039010048","type":"CDM"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":1510.0,"discounted_cash":1057.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRYOPRECIPITATE EACH UNIT POOLED","code_information":[{"code":"Px00039010054","type":"CDM"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED","code_information":[{"code":"Px00039010055","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLATELETS PHERESIS PATH REDU","code_information":[{"code":"Px00039010064","type":"CDM"},{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"gross_charge":1510.0,"discounted_cash":1057.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD TRANSFUSION EA UNIT CDM","code_information":[{"code":"Px00039110001","type":"CDM"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RBC LEUKOREDUCED IRRADIATED WASHED","code_information":[{"code":"Px00039910006","type":"CDM"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SCREENING BREAST TOMOSYNTHESIS BI","code_information":[{"code":"Px00040110020","type":"CDM"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TOMOSYNTHESIS MAMMO UNI OR BIL DIAGNOSTIC","code_information":[{"code":"Px00040110021","type":"CDM"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAM OF HEAD","code_information":[{"code":"Px00040210001","type":"CDM"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1414.0,"discounted_cash":989.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US EXAM OF HEAD AND NECK","code_information":[{"code":"Px00040210004","type":"CDM"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1023.0,"discounted_cash":716.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US EXAM CHEST","code_information":[{"code":"Px00040210005","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.0,"discounted_cash":641.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US EXAM ABDOMEN COMPLETE","code_information":[{"code":"Px00040210008","type":"CDM"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":770.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US EXAM PELVIC LIMITED","code_information":[{"code":"Px00040210009","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":615.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US RETROPERITONEAL COMPLETE","code_information":[{"code":"Px00040210010","type":"CDM"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":784.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US RETROPERITONEAL LIMITED","code_information":[{"code":"Px00040210011","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":674.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US EXAM KIDNEY TRANSPLANT W/DOPPLER","code_information":[{"code":"Px00040210012","type":"CDM"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":755.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US OB LT 14 WKS SINGLE FETUS CDM","code_information":[{"code":"Px00040210014","type":"CDM"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1316.0,"discounted_cash":921.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US OB LT 14 WKS ADDL FETUS CDM","code_information":[{"code":"Px00040210015","type":"CDM"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":607.0,"discounted_cash":424.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US OB AFTER 1ST TRIMEST 1/1ST FETUS","code_information":[{"code":"Px00040210016","type":"CDM"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1189.0,"discounted_cash":832.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US OB AFTER 1ST TRIMESTER ADD FETUS","code_information":[{"code":"Px00040210017","type":"CDM"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.0,"discounted_cash":1001.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US OB DETAILED SINGLE FETUS CDM","code_information":[{"code":"Px00040210018","type":"CDM"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":1266.0,"discounted_cash":886.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US OB NUCHAL MEASUREMENT 1 GEST CDM","code_information":[{"code":"Px00040210020","type":"CDM"},{"code":"76813","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":648.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US OB NUCHAL MEASUREMENT ADD GEST CDM","code_information":[{"code":"Px00040210021","type":"CDM"},{"code":"76814","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US OB LIMITED FETUS(S) CDM","code_information":[{"code":"Px00040210022","type":"CDM"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.0,"discounted_cash":693.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US OB FOLLOW-UP PER FETUS CDM","code_information":[{"code":"Px00040210023","type":"CDM"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1199.0,"discounted_cash":839.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US OB TRANSVAGINAL CDM","code_information":[{"code":"Px00040210024","type":"CDM"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":1078.0,"discounted_cash":754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US FETAL BIOPHYS PROFILE W/NST CDM","code_information":[{"code":"Px00040210025","type":"CDM"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.0,"discounted_cash":976.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US FETAL BIOPHYS PROFILE W/O NST CDM","code_information":[{"code":"Px00040210026","type":"CDM"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":584.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US TRANSVAGINAL NON-OB","code_information":[{"code":"Px00040210033","type":"CDM"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1063.0,"discounted_cash":744.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US EXAM PELVIC FOLLICLE LIMITED","code_information":[{"code":"Px00040210035","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":615.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US EXAM SCROTUM & CONTENTS","code_information":[{"code":"Px00040210036","type":"CDM"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1034.0,"discounted_cash":723.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US TRANSRECTAL","code_information":[{"code":"Px00040210037","type":"CDM"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US JOINT COMPLETE","code_information":[{"code":"Px00040210041","type":"CDM"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM","code_information":[{"code":"Px00040210043","type":"CDM"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US GUIDE VASCULAR ACCESS","code_information":[{"code":"Px00040210049","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":362.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US GUIDANCE NEEDLE PLACEMENT IMG S&I CDM","code_information":[{"code":"Px00040210052","type":"CDM"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.0,"discounted_cash":641.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ECHO GUIDE FOR AMNIOCENTESIS CDM","code_information":[{"code":"Px00040210053","type":"CDM"},{"code":"76946","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.0,"discounted_cash":585.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US GUIDE INTRAOPERATIVE","code_information":[{"code":"Px00040210059","type":"CDM"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":907.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ECHO EXAMINATION PROCEDURE UNLISTED","code_information":[{"code":"Px00040210061","type":"CDM"},{"code":"76999","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.0,"discounted_cash":464.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US PELVIC NON-OB COMPLETE","code_information":[{"code":"Px00040210093","type":"CDM"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":1217.0,"discounted_cash":851.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US ABDOMEN LIMITED","code_information":[{"code":"Px00040210104","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":523.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM","code_information":[{"code":"Px00040210112","type":"CDM"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":170.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US BREAST UNI COMPLETE","code_information":[{"code":"Px00040210136","type":"CDM"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US BREAST UNI LIMITED","code_information":[{"code":"Px00040210137","type":"CDM"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US ABD AORTA SCRN AAA","code_information":[{"code":"Px00040210142","type":"CDM"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US TARGET DYNAMIC MICROBUBBLE 1ST LESION","code_information":[{"code":"Px00040210148","type":"CDM"},{"code":"76978","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":479.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LES","code_information":[{"code":"Px00040210149","type":"CDM"},{"code":"76979","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ULTRASOUND ELASTOGRAPHY PARENCHYMA","code_information":[{"code":"Px00040210150","type":"CDM"},{"code":"76981","type":"HCPCS"}],"standard_charges":[{"gross_charge":1016.0,"discounted_cash":711.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION","code_information":[{"code":"Px00040210151","type":"CDM"},{"code":"76982","type":"HCPCS"}],"standard_charges":[{"gross_charge":1016.0,"discounted_cash":711.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US ELASTOGRAPHY EA ADDL TARGET LESION","code_information":[{"code":"Px00040210152","type":"CDM"},{"code":"76983","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MAMMO SCREEN BIL W CAD","code_information":[{"code":"Px00040310004","type":"CDM"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MAMMO SCREEN UNIL/BIL W CAD","code_information":[{"code":"Px00040310005","type":"CDM"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INTUBATION CDM","code_information":[{"code":"Px00041010003","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD SAMPLING CAPILLARY CDM","code_information":[{"code":"Px00041010004","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BLOOD DRAW ARTERIAL PUNCTURE CDM","code_information":[{"code":"Px00041010006","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00041010007","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PULMONARY MECHANICS (VITAL CAPACITY TOTAL -  SEPARATE PROCEDURE)","code_information":[{"code":"Px00041010008","type":"CDM"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CONTINUOUS INHALATION TREATMENT/NITROGEN THERAPY EA ADDL HOUR","code_information":[{"code":"Px00041010009","type":"CDM"},{"code":"94645","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ","code_information":[{"code":"Px00041010010","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PULSE OXIMETRY MULT MEASUREMENTS ONCE/DAY CDM","code_information":[{"code":"Px00041010012","type":"CDM"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PULSE OXIMETRY OVERNIGHT STUDY CDM","code_information":[{"code":"Px00041010013","type":"CDM"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL CHEST WALL OSCILL CDM","code_information":[{"code":"Px00041010023","type":"CDM"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CONTINUOUS INHALATION TREATMENT EA ADDL HR","code_information":[{"code":"Px00041010237","type":"CDM"},{"code":"94645","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL CDM","code_information":[{"code":"Px00041010261","type":"CDM"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ CDM","code_information":[{"code":"Px00041010263","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL VENTILATION FIRST DAY CDM","code_information":[{"code":"Px00041010290","type":"CDM"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1180.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MECHANICAL VENTILATION SUBSEQUENT DAY CDM","code_information":[{"code":"Px00041010296","type":"CDM"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":2075.0,"discounted_cash":1452.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NONINVASIVE VENTILATION/CPAP DAILY CDM","code_information":[{"code":"Px00041010325","type":"CDM"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NONINVASIVE VENTILATION/CPAP SUBSEQUENT DAY CDM","code_information":[{"code":"Px00041010328","type":"CDM"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":339.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PULM REHAB GROUP CDM","code_information":[{"code":"Px00041010331","type":"CDM"},{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PULM REHAB RESP FUNCTION, INDIV CDM","code_information":[{"code":"Px00041010332","type":"CDM"},{"code":"G0238","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PERCUSSION VIBRATION POSTURAL DRAINAGE 3 POSITIONS OR LESS","code_information":[{"code":"Px00041010338","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PERCUSSION VIBRATPOSTURAL DRAINAGE GT/4 POSITIONS CDM","code_information":[{"code":"Px00041010341","type":"CDM"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PULM REHAB STRENGTH/ENDURANCE, INDIV CDM","code_information":[{"code":"Px00041010363","type":"CDM"},{"code":"G0237","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CONGENITAL HEART DISEASE SCREEN PULSE OX MULT DET","code_information":[{"code":"Px00041010384","type":"CDM"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT","code_information":[{"code":"Px00041010406","type":"CDM"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INHALATION TREATMENT DAILY","code_information":[{"code":"Px00041210006","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH","code_information":[{"code":"Px00041210007","type":"CDM"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CONTINUOUS INHALATION TREATMENT 1ST HR CDM","code_information":[{"code":"Px00041210008","type":"CDM"},{"code":"94644","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DEMO AND/OR EVAL-PT UTILIZATION OF NEBULIZER/INHALER/IPPB/AEROSOL DEVICE","code_information":[{"code":"Px00041210009","type":"CDM"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NEBULIZER CONTINUOUS EA SUBSEQUENT HOUR CDM","code_information":[{"code":"Px00041210044","type":"CDM"},{"code":"94645","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ORTHOTIC/PROSTH MGMT & TRAINING SBSQ ENCTR PER 15MIN","code_information":[{"code":"Px00042010003","type":"CDM"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":51.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES CDM","code_information":[{"code":"Px00042010010","type":"CDM"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES CDM","code_information":[{"code":"Px00042010011","type":"CDM"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM","code_information":[{"code":"Px00042010014","type":"CDM"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97112 NEUROMUSCUL REEDUCAT EA 15 MIN CDM","code_information":[{"code":"Px00042010015","type":"CDM"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97116 GAIT TRAINING THERAPY EA 15 MIN CDM","code_information":[{"code":"Px00042010016","type":"CDM"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97750 PHYSICAL PERFORMANCE TEST EA 15 MIN","code_information":[{"code":"Px00042010017","type":"CDM"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97760 ORTHOTIC MGMT AND TRAINING EA 15 MIN","code_information":[{"code":"Px00042010018","type":"CDM"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC STRAPPING UNNA BOOT","code_information":[{"code":"Px00042010080","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT BIL","code_information":[{"code":"Px00042010083","type":"CDM"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT","code_information":[{"code":"Px00042010084","type":"CDM"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RANGE OF MOTION MEASUREMENTS - EXTREMTY/TRUNK","code_information":[{"code":"Px00042010107","type":"CDM"},{"code":"95851","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CANALITH REPOSITIONING PROCEDURE - PER DAY","code_information":[{"code":"Px00042010108","type":"CDM"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS TRACTION MECHANICAL","code_information":[{"code":"Px00042010110","type":"CDM"},{"code":"97012","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS ELEC STIMJ UNATTENDED","code_information":[{"code":"Px00042010113","type":"CDM"},{"code":"97014","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS VASOPNEUMATIC DEVICES","code_information":[{"code":"Px00042010114","type":"CDM"},{"code":"97016","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APPLICATION MODALITY 1 OR MORE AREAS WHIRLPOOL","code_information":[{"code":"Px00042010117","type":"CDM"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":70.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INFRARED THERAPY","code_information":[{"code":"Px00042010121","type":"CDM"},{"code":"97026","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS ATTENDED ESTIM EA 15 MIN","code_information":[{"code":"Px00042010124","type":"CDM"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS IONTOPHORESIS EA 15 MIN","code_information":[{"code":"Px00042010125","type":"CDM"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS CONTRAST BATHS EA 15 MIN","code_information":[{"code":"Px00042010126","type":"CDM"},{"code":"97034","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS ULTRASOUND EA 15 MIN","code_information":[{"code":"Px00042010127","type":"CDM"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN","code_information":[{"code":"Px00042010131","type":"CDM"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN","code_information":[{"code":"Px00042010139","type":"CDM"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC AQUATIC THERAPY/EXERCISES - 15 MIN","code_information":[{"code":"Px00042010141","type":"CDM"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THER PX 1 OR MORE AREAS EA 15 MIN GAIT TRAING W/STAIR","code_information":[{"code":"Px00042010142","type":"CDM"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THER PX 1 OR MORE AREAS EACH 15 MINUTES MASSAGE","code_information":[{"code":"Px00042010144","type":"CDM"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES","code_information":[{"code":"Px00042010150","type":"CDM"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THERAPEUTIC PROCEDURES GROUP 2 OR MORE INDIVIDUALS","code_information":[{"code":"Px00042010153","type":"CDM"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","code_information":[{"code":"Px00042010160","type":"CDM"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC WHEELCHAIR MGMT EA 15 MIN","code_information":[{"code":"Px00042010165","type":"CDM"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT OPEN WOUND 20 SQ CM OR LESS","code_information":[{"code":"Px00042010166","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","code_information":[{"code":"Px00042010173","type":"CDM"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS","code_information":[{"code":"Px00042010182","type":"CDM"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NEG PRESS WOUND TX UTILIZING DME EQUIP LTE/50 SQ CM","code_information":[{"code":"Px00042010188","type":"CDM"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NEG PRESS WOUND TX UTILIZING DME EQUIP GT/50 SQ CM","code_information":[{"code":"Px00042010195","type":"CDM"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":222.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN","code_information":[{"code":"Px00042010248","type":"CDM"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":62.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS","code_information":[{"code":"Px00042010264","type":"CDM"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PROSTHETICS TRAINING INITIAL ENCTR EA 15 MINS","code_information":[{"code":"Px00042010265","type":"CDM"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":53.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ELEC STIM UNATTENDED TO 1 OR MORE AREAS OTHER THAN WOUND CARE","code_information":[{"code":"Px00042010270","type":"CDM"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042410066","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION  MOD COMPLEX CDM","code_information":[{"code":"Px00042410067","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00042410068","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PT RE-EVAL EST PLAN CARE 20 MINS","code_information":[{"code":"Px00042410069","type":"CDM"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97161 PT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00042410070","type":"CDM"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97162 PT EVALUATION  MOD COMPLEX CDM","code_information":[{"code":"Px00042410071","type":"CDM"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97163 PT EVALUATION HIGH COMPLEX CDM","code_information":[{"code":"Px00042410072","type":"CDM"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97164 PT RE-EVAL ESTAB PLAN OF CARE CDM","code_information":[{"code":"Px00042410073","type":"CDM"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC APPL MODALITY 1 OR MORE AREAS PARAFFIN BATH","code_information":[{"code":"Px00043010004","type":"CDM"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97535 SELF CARE MGMT TRAINING EA 15 MIN CDM","code_information":[{"code":"Px00043010005","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","code_information":[{"code":"Px00043010007","type":"CDM"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","code_information":[{"code":"Px00043010008","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SELF CARE MNGMENT TRAINING - ADL","code_information":[{"code":"Px00043010013","type":"CDM"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COMMUNITY/WORK REINTEGRATION EA 15 MIN","code_information":[{"code":"Px00043010014","type":"CDM"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION LOW COMPLEX","code_information":[{"code":"Px00043410045","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION MOD COMPLEXITY","code_information":[{"code":"Px00043410046","type":"CDM"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OT EVALUATION HIGH COMPLEX","code_information":[{"code":"Px00043410047","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OT RE-EVALUATION ESTABLISHED PLAN OF CARE","code_information":[{"code":"Px00043410048","type":"CDM"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97165 OT EVALUATION LOW COMPLEX CDM","code_information":[{"code":"Px00043410050","type":"CDM"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97166 OT EVALUATION MOD COMPLEXITY CDM","code_information":[{"code":"Px00043410051","type":"CDM"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 97167 OT EVALUATION HIGH COMPLEX CDM","code_information":[{"code":"Px00043410052","type":"CDM"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL","code_information":[{"code":"Px00044010016","type":"CDM"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPEECH LANG VOICE COMMJ AUDITRY - GROUP 2 OR MORE CDM","code_information":[{"code":"Px00044010024","type":"CDM"},{"code":"92508","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":93.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ORAL FUNCTION THERAPY","code_information":[{"code":"Px00044010042","type":"CDM"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ORAL SPEECH DEVICE EVAL","code_information":[{"code":"Px00044010050","type":"CDM"},{"code":"92597","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NON-SPEECH DEVICE SERVICE","code_information":[{"code":"Px00044010055","type":"CDM"},{"code":"92606","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC USE OF SPEECH DEVICE SERVICE CDM","code_information":[{"code":"Px00044010068","type":"CDM"},{"code":"92609","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC OTORHINOLARYNGOLOGICAL SERVICE/PX","code_information":[{"code":"Px00044010069","type":"CDM"},{"code":"92700","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ASSESSMENT OF APHASIA PER HOUR","code_information":[{"code":"Px00044010074","type":"CDM"},{"code":"96105","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM","code_information":[{"code":"Px00044010076","type":"CDM"},{"code":"96110","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":219.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC STANDARDIZED COGNITIVE PERFORMANCE TESTING PER HOUR CDM","code_information":[{"code":"Px00044010083","type":"CDM"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM","code_information":[{"code":"Px00044010126","type":"CDM"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE CDM","code_information":[{"code":"Px00044010127","type":"CDM"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":104.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92507 SPEECH/HEARING THERAPY - INDIV CDM","code_information":[{"code":"Px00044010145","type":"CDM"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EX FOR SPEECH DEVICE RX 1HR","code_information":[{"code":"Px00044410022","type":"CDM"},{"code":"92607","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EX FOR SPEECH DEVICE RX EA ADDL 30 MIN","code_information":[{"code":"Px00044410025","type":"CDM"},{"code":"92608","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EVALUATE SWALLOWING FUNCTION","code_information":[{"code":"Px00044410026","type":"CDM"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":194.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MOTION FLUOROSCOPY/SWALLOW","code_information":[{"code":"Px00044410043","type":"CDM"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY SWALLOW TST (FEES)","code_information":[{"code":"Px00044410054","type":"CDM"},{"code":"92612","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EVALUATION OF SPEECH FLUENCY","code_information":[{"code":"Px00044410063","type":"CDM"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE CDM","code_information":[{"code":"Px00044410064","type":"CDM"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92521 EVALUATION OF SPEECH FLUENCY CDM","code_information":[{"code":"Px00044410070","type":"CDM"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92522 EVALUATE SPEECH PRODUCTION CDM","code_information":[{"code":"Px00044410071","type":"CDM"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92523 SPEECH SOUND LANG COMPREHEN CDM","code_information":[{"code":"Px00044410072","type":"CDM"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CRISIS TELEH 92524 BEHAVRAL QUALIT ANALYS VOICE CDM","code_information":[{"code":"Px00044410073","type":"CDM"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":104.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION CDM","code_information":[{"code":"Px00045000001","type":"CDM"},{"code":"28675","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00045000002","type":"CDM"},{"code":"27570","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TAP BLOCK BILATERAL BY INJECTION(S) CDM","code_information":[{"code":"Px00045000003","type":"CDM"},{"code":"64488","type":"HCPCS"}],"standard_charges":[{"gross_charge":2642.0,"discounted_cash":1849.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP CDM","code_information":[{"code":"Px00045000005","type":"CDM"},{"code":"46255","type":"HCPCS"}],"standard_charges":[{"gross_charge":5493.0,"discounted_cash":3845.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN CDM","code_information":[{"code":"Px00045000006","type":"CDM"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD FEM NRV CONT NFS CATH IMG GDN CDM","code_information":[{"code":"Px00045000007","type":"CDM"},{"code":"64448","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM CDM","code_information":[{"code":"Px00045000008","type":"CDM"},{"code":"57022","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL CDM","code_information":[{"code":"Px00045000009","type":"CDM"},{"code":"42330","type":"HCPCS"}],"standard_charges":[{"gross_charge":6081.0,"discounted_cash":4256.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM CDM","code_information":[{"code":"Px00045000012","type":"CDM"},{"code":"11307","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ASPIRATION AND/OR INJECTION THYROID CYST CDM","code_information":[{"code":"Px00045000013","type":"CDM"},{"code":"60300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL TISSUE EXPANDER W/O INSERTION IMPLANT CDM","code_information":[{"code":"Px00045000014","type":"CDM"},{"code":"11971","type":"HCPCS"}],"standard_charges":[{"gross_charge":7104.0,"discounted_cash":4972.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCISION FLEXOR TENDON SHEATH WRIST CDM","code_information":[{"code":"Px00045000015","type":"CDM"},{"code":"25001","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON CDM","code_information":[{"code":"Px00045000016","type":"CDM"},{"code":"26460","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TONSIL ASPIRATION CDM","code_information":[{"code":"Px00045000017","type":"CDM"},{"code":"45000017","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":400.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT CDM","code_information":[{"code":"Px00045000019","type":"CDM"},{"code":"27496","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TAP BLOCK UNILATERAL BY INJECTION(S) CDM","code_information":[{"code":"Px00045000020","type":"CDM"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION INTRALESIONAL UP TO AND INCLUD 7 LESIONS CDM","code_information":[{"code":"Px00045000021","type":"CDM"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RECTUM FOREIGN BODY REMOVAL WITH SPECULUM AND/OR FORCEPS CDM","code_information":[{"code":"Px00045000022","type":"CDM"},{"code":"45999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2286.0,"discounted_cash":1600.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION CERVICAL DILATOR SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00045000023","type":"CDM"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":437.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED J TUBE REPLACEMENT CDM","code_information":[{"code":"Px00045000024","type":"CDM"},{"code":"44799","type":"HCPCS"}],"standard_charges":[{"gross_charge":2270.0,"discounted_cash":1589.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ CDM","code_information":[{"code":"Px00045000025","type":"CDM"},{"code":"28496","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOID REDUCTION VIA FORCEP CDM","code_information":[{"code":"Px00045000030","type":"CDM"},{"code":"46999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2286.0,"discounted_cash":1600.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP CDM","code_information":[{"code":"Px00045000032","type":"CDM"},{"code":"98975","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TOCILIZUMAUB INFUSION ADMIN 1ST DOSE M0249","code_information":[{"code":"Px00045000033","type":"CDM"},{"code":"M0249","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO TRUNK/ARMS/LEGS TO 100 SQ CM 1ST 25 SQ CM","code_information":[{"code":"Px00045000051","type":"CDM"},{"code":"C5271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":868.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO TRNK/ARMS/LEGS TO 100 SQ CM EA ADD 25 SQ CM","code_information":[{"code":"Px00045000052","type":"CDM"},{"code":"C5272","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO TRNK/ARMS/LEGS GT/ 100 SQ CM 1ST 100 SQ CM","code_information":[{"code":"Px00045000053","type":"CDM"},{"code":"C5273","type":"HCPCS"}],"standard_charges":[{"gross_charge":3689.0,"discounted_cash":2582.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO TRNK/ARMS/LEGS GT/100 SQ CM EA ADD 100 SQCM","code_information":[{"code":"Px00045000054","type":"CDM"},{"code":"C5274","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO FACE/NECK/HAND/FEET TO 100 SQ CM 1ST 25 SQCM","code_information":[{"code":"Px00045000055","type":"CDM"},{"code":"C5275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":868.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO FACE/NECK/HAND/FEET EA ADD 25 SQ CM","code_information":[{"code":"Px00045000056","type":"CDM"},{"code":"C5276","type":"HCPCS"}],"standard_charges":[{"gross_charge":1063.0,"discounted_cash":744.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUBST APP TO FACE/NECK/HAND/FEET 1ST 100 SQCM","code_information":[{"code":"Px00045000057","type":"CDM"},{"code":"C5277","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":868.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LOW COST SKIN SUB APP TO FACE/NECK/HAND/FEET EA ADD 100 SQCM","code_information":[{"code":"Px00045000058","type":"CDM"},{"code":"C5278","type":"HCPCS"}],"standard_charges":[{"gross_charge":3513.0,"discounted_cash":2459.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN CDM","code_information":[{"code":"Px00045000059","type":"CDM"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NJX ANES STELLATE GANGLION CRV SYMPATHETIC CDM","code_information":[{"code":"Px00045000060","type":"CDM"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS CDM","code_information":[{"code":"Px00045000061","type":"CDM"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR CDM","code_information":[{"code":"Px00045000062","type":"CDM"},{"code":"41825","type":"HCPCS"}],"standard_charges":[{"gross_charge":6081.0,"discounted_cash":4256.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH CDM","code_information":[{"code":"Px00045000063","type":"CDM"},{"code":"64600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG CDM","code_information":[{"code":"Px00045000064","type":"CDM"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL CDM","code_information":[{"code":"Px00045000065","type":"CDM"},{"code":"10004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":786.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT CDM","code_information":[{"code":"Px00045000066","type":"CDM"},{"code":"53855","type":"HCPCS"}],"standard_charges":[{"gross_charge":3964.0,"discounted_cash":2774.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN CDM","code_information":[{"code":"Px00045000067","type":"CDM"},{"code":"49421","type":"HCPCS"}],"standard_charges":[{"gross_charge":9740.0,"discounted_cash":6818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL CDM","code_information":[{"code":"Px00045000068","type":"CDM"},{"code":"42320","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH CDM","code_information":[{"code":"Px00045000069","type":"CDM"},{"code":"47535","type":"HCPCS"}],"standard_charges":[{"gross_charge":9740.0,"discounted_cash":6818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I CDM","code_information":[{"code":"Px00045000070","type":"CDM"},{"code":"47536","type":"HCPCS"}],"standard_charges":[{"gross_charge":9740.0,"discounted_cash":6818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION PILONIDAL CYST/SINUS COMPLICATED CDM","code_information":[{"code":"Px00045000071","type":"CDM"},{"code":"11772","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DSTRJ NEUROFIBROMATA XTNSV FACE HEAD NECK GT/50 CDM","code_information":[{"code":"Px00045000072","type":"CDM"},{"code":"0419T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1597.0,"discounted_cash":1117.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DSTRJ NEUROFIBROMATA XTNSV TRUNK EXTGT/100 CDM","code_information":[{"code":"Px00045000073","type":"CDM"},{"code":"0420T","type":"HCPCS"}],"standard_charges":[{"gross_charge":1597.0,"discounted_cash":1117.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION OF CATHETER VEIN CDM","code_information":[{"code":"Px00045000074","type":"CDM"},{"code":"36481","type":"HCPCS"}],"standard_charges":[{"gross_charge":924.0,"discounted_cash":646.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY SOFT TISSUE NECK/THORAX CDM","code_information":[{"code":"Px00045000076","type":"CDM"},{"code":"21550","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD BRACH PLEX CONT NFS CATH IMG CDM","code_information":[{"code":"Px00045000077","type":"CDM"},{"code":"64416","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SALIVARY STONE CDM","code_information":[{"code":"Px00045000078","type":"CDM"},{"code":"42699","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF CDM","code_information":[{"code":"Px00045000080","type":"CDM"},{"code":"35876","type":"HCPCS"}],"standard_charges":[{"gross_charge":14840.0,"discounted_cash":10388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ABDOMINAL WOUND DEHISCENSE TREATMENT CDM","code_information":[{"code":"Px00045000081","type":"CDM"},{"code":"49900","type":"HCPCS"}],"standard_charges":[{"gross_charge":12652.0,"discounted_cash":8856.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED VBAC DELIVERY ONLY CDM","code_information":[{"code":"Px00045000082","type":"CDM"},{"code":"59612","type":"HCPCS"}],"standard_charges":[{"gross_charge":7776.0,"discounted_cash":5443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED AMPUTATION TOE INTERPHALANGEAL JOINT CDM","code_information":[{"code":"Px00045000083","type":"CDM"},{"code":"28825","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED URETHRAL FB REMOVAL CDM","code_information":[{"code":"Px00045000084","type":"CDM"},{"code":"53899","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":413.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EGD PLACE GASTROSTOMY TUBE CDM","code_information":[{"code":"Px00045000085","type":"CDM"},{"code":"43246","type":"HCPCS"}],"standard_charges":[{"gross_charge":4343.0,"discounted_cash":3040.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES CDM","code_information":[{"code":"Px00045000086","type":"CDM"},{"code":"41899","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":400.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL ANAL SETON OTHER MARKER CDM","code_information":[{"code":"Px00045000087","type":"CDM"},{"code":"46030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2315.0,"discounted_cash":1620.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC BARTHOLINS GLAND/CYST CDM","code_information":[{"code":"Px00045000088","type":"CDM"},{"code":"56740","type":"HCPCS"}],"standard_charges":[{"gross_charge":6044.0,"discounted_cash":4230.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSU CDM","code_information":[{"code":"Px00045000089","type":"CDM"},{"code":"65290","type":"HCPCS"}],"standard_charges":[{"gross_charge":10094.0,"discounted_cash":7065.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYTIC VENOUS THERAPY CDM","code_information":[{"code":"Px00045000090","type":"CDM"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":8192.0,"discounted_cash":5734.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL CDM","code_information":[{"code":"Px00045000091","type":"CDM"},{"code":"67015","type":"HCPCS"}],"standard_charges":[{"gross_charge":6236.0,"discounted_cash":4365.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BRNCHSC RF DSTRJ PULM NRV BI MAINSTEM BRONCHI CDM","code_information":[{"code":"Px00045000092","type":"CDM"},{"code":"0781T","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BRNCHSC RF DSTRJ PULM NRV UNI MAINSTEM BRONCHUS CDM","code_information":[{"code":"Px00045000093","type":"CDM"},{"code":"0782T","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00045000096","type":"CDM"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00045000097","type":"CDM"},{"code":"15854","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SUBCONJUNCTIVAL INJECTION CDM","code_information":[{"code":"Px00045000098","type":"CDM"},{"code":"68200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.0,"discounted_cash":763.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR CDM","code_information":[{"code":"Px00045000099","type":"CDM"},{"code":"35860","type":"HCPCS"}],"standard_charges":[{"gross_charge":8601.0,"discounted_cash":6020.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SUTURE PHARYNX WOUND/INJURY CDM","code_information":[{"code":"Px00045000100","type":"CDM"},{"code":"42900","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY OF FLOOR OF MOUTH CDM","code_information":[{"code":"Px00045000107","type":"CDM"},{"code":"41108","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS CDM","code_information":[{"code":"Px00045000108","type":"CDM"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PRTL HYMENECTOMY/REV HYMENAL RING CDM","code_information":[{"code":"Px00045000109","type":"CDM"},{"code":"56700","type":"HCPCS"}],"standard_charges":[{"gross_charge":7776.0,"discounted_cash":5443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES CDM","code_information":[{"code":"Px00045000110","type":"CDM"},{"code":"20693","type":"HCPCS"}],"standard_charges":[{"gross_charge":18191.0,"discounted_cash":12733.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ CDM","code_information":[{"code":"Px00045000116","type":"CDM"},{"code":"21485","type":"HCPCS"}],"standard_charges":[{"gross_charge":6368.0,"discounted_cash":4457.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY VULVA/PERINEUM 1 LESION SPX CDM","code_information":[{"code":"Px00045000121","type":"CDM"},{"code":"56605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1723.0,"discounted_cash":1206.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NEG PRESSURE WOUND THERAPY UTI DISPOSABLE NON-DME LTE 50SQ","code_information":[{"code":"Px00045000122","type":"CDM"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED 68020 INCISION CONJUNCTIVA DRAINAGE OF CYST CDM","code_information":[{"code":"Px00045000125","type":"CDM"},{"code":"68020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2653.0,"discounted_cash":1857.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY CDM","code_information":[{"code":"Px00045000127","type":"CDM"},{"code":"27385","type":"HCPCS"}],"standard_charges":[{"gross_charge":17148.0,"discounted_cash":12003.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX","code_information":[{"code":"Px00045000132","type":"CDM"},{"code":"61020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2171.0,"discounted_cash":1519.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NEGATIVE PRESSURE WOUND THERAPY DME >50 SQCM CDM","code_information":[{"code":"Px00045000133","type":"CDM"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":699.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NEGATIVE PRESSURE WOUND THERAPY NON-DME >50 SQCM CDM","code_information":[{"code":"Px00045000134","type":"CDM"},{"code":"97608","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":699.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUCTION VAGINAL LESIONS SIMPLE CDM","code_information":[{"code":"Px00045000135","type":"CDM"},{"code":"57061","type":"HCPCS"}],"standard_charges":[{"gross_charge":7949.0,"discounted_cash":5564.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US ED EXAM CHEST CDM","code_information":[{"code":"Px00045000136","type":"CDM"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":583.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US ED LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM","code_information":[{"code":"Px00045000137","type":"CDM"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":154.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US ED ABDOMEN LIMITED CDM","code_information":[{"code":"Px00045000139","type":"CDM"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.0,"discounted_cash":476.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US ED ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD CDM","code_information":[{"code":"Px00045000140","type":"CDM"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US ED EXAM OF HEAD AND NECK CDM","code_information":[{"code":"Px00045000141","type":"CDM"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":651.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US ED EXAM PELVIC LIMITED CDM","code_information":[{"code":"Px00045000142","type":"CDM"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":799.0,"discounted_cash":559.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US ED OB LIMITED FETUS(S) CDM","code_information":[{"code":"Px00045000143","type":"CDM"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.0,"discounted_cash":630.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US ED RETROPERITONEAL LIMITED CDM","code_information":[{"code":"Px00045000144","type":"CDM"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC US ED BREAST UNI LIMITED CDM","code_information":[{"code":"Px00045000145","type":"CDM"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":198.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT BIG TOE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045001299","type":"CDM"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ACNE SURGERY CDM","code_information":[{"code":"Px00045001301","type":"CDM"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CURETTAGE POSTPARTUM CDM","code_information":[{"code":"Px00045001309","type":"CDM"},{"code":"59160","type":"HCPCS"}],"standard_charges":[{"gross_charge":7776.0,"discounted_cash":5443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE DRUG IMPLANT DEVICE CDM","code_information":[{"code":"Px00045001312","type":"CDM"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":564.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DECOMPRESS FASCIOTOMY FINGERS/HAND CDM","code_information":[{"code":"Px00045001313","type":"CDM"},{"code":"26037","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LIGATION OF EXTERMITY ARTERY CDM","code_information":[{"code":"Px00045010001","type":"CDM"},{"code":"37618","type":"HCPCS"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":725.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM CDM","code_information":[{"code":"Px00045010002","type":"CDM"},{"code":"14061","type":"HCPCS"}],"standard_charges":[{"gross_charge":4746.0,"discounted_cash":3322.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INHALATION TREATMENT CDM","code_information":[{"code":"Px00045010003","type":"CDM"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC CDM","code_information":[{"code":"Px00045010004","type":"CDM"},{"code":"21110","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM","code_information":[{"code":"Px00045010005","type":"CDM"},{"code":"49505","type":"HCPCS"}],"standard_charges":[{"gross_charge":7571.0,"discounted_cash":5299.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED CDM","code_information":[{"code":"Px00045010006","type":"CDM"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":5557.0,"discounted_cash":3889.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERQ PRCRD DRG GTE 6YR W/O CONGENITAL CAR ANOMALY CDM","code_information":[{"code":"Px00045010007","type":"CDM"},{"code":"33017","type":"HCPCS"}],"standard_charges":[{"gross_charge":5557.0,"discounted_cash":3889.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY CDM","code_information":[{"code":"Px00045010008","type":"CDM"},{"code":"33018","type":"HCPCS"}],"standard_charges":[{"gross_charge":5557.0,"discounted_cash":3889.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT CDM","code_information":[{"code":"Px00045010009","type":"CDM"},{"code":"33019","type":"HCPCS"}],"standard_charges":[{"gross_charge":5557.0,"discounted_cash":3889.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ FACIAL CDM","code_information":[{"code":"Px00045010010","type":"CDM"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":523.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT CDM","code_information":[{"code":"Px00045010011","type":"CDM"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT CDM","code_information":[{"code":"Px00045010012","type":"CDM"},{"code":"62329","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG CDM","code_information":[{"code":"Px00045010013","type":"CDM"},{"code":"64451","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR CDM","code_information":[{"code":"Px00045010014","type":"CDM"},{"code":"15738","type":"HCPCS"}],"standard_charges":[{"gross_charge":8946.0,"discounted_cash":6262.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM CDM","code_information":[{"code":"Px00045010015","type":"CDM"},{"code":"14301","type":"HCPCS"}],"standard_charges":[{"gross_charge":8946.0,"discounted_cash":6262.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM CDM","code_information":[{"code":"Px00045010016","type":"CDM"},{"code":"14302","type":"HCPCS"}],"standard_charges":[{"gross_charge":3562.0,"discounted_cash":2493.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG CDM","code_information":[{"code":"Px00045010017","type":"CDM"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NEEDLE INSERTION W/O INJECTION 1 OR 2 MUSCLES CDM","code_information":[{"code":"Px00045010018","type":"CDM"},{"code":"20560","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INDUCTION OF VOMITING CDM","code_information":[{"code":"Px00045010019","type":"CDM"},{"code":"99175","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NEEDLE INSERTION W/O INJECTION 3 OR MORE MUSCLES CDM","code_information":[{"code":"Px00045010020","type":"CDM"},{"code":"20561","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES CDM","code_information":[{"code":"Px00045010021","type":"CDM"},{"code":"30310","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF NOSE LESION CDM","code_information":[{"code":"Px00045010023","type":"CDM"},{"code":"30000","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF NASAL SEPTUM ABSCESS/HEMATOMA CDM","code_information":[{"code":"Px00045010024","type":"CDM"},{"code":"30020","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":277.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE NASAL FOREIGN BODY CDM","code_information":[{"code":"Px00045010025","type":"CDM"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ABLATE INF TURBINATE SUPERFICIAL CDM","code_information":[{"code":"Px00045010027","type":"CDM"},{"code":"30801","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL OF NOSEBLEED SIMPLE CDM","code_information":[{"code":"Px00045010028","type":"CDM"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL OF NOSEBLEED COMPLEX CDM","code_information":[{"code":"Px00045010030","type":"CDM"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST CDM","code_information":[{"code":"Px00045010031","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 CDM","code_information":[{"code":"Px00045010032","type":"CDM"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 CDM","code_information":[{"code":"Px00045010033","type":"CDM"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION GT/4 CDM","code_information":[{"code":"Px00045010034","type":"CDM"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM OR LESS CDM","code_information":[{"code":"Px00045010035","type":"CDM"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM CDM","code_information":[{"code":"Px00045010036","type":"CDM"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM CDM","code_information":[{"code":"Px00045010037","type":"CDM"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L GT/4.0 CM CDM","code_information":[{"code":"Px00045010038","type":"CDM"},{"code":"11406","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G GT/4.0CM CDM","code_information":[{"code":"Px00045010039","type":"CDM"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM CDM","code_information":[{"code":"Px00045010040","type":"CDM"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM CDM","code_information":[{"code":"Px00045010041","type":"CDM"},{"code":"11443","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TRIMMING NONDYSTROPHIC NAILS ANY NUMBER CDM","code_information":[{"code":"Px00045010042","type":"CDM"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT CDM","code_information":[{"code":"Px00045010043","type":"CDM"},{"code":"15002","type":"HCPCS"}],"standard_charges":[{"gross_charge":4746.0,"discounted_cash":3322.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT CDM","code_information":[{"code":"Px00045010044","type":"CDM"},{"code":"15003","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT CDM","code_information":[{"code":"Px00045010045","type":"CDM"},{"code":"15004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1597.0,"discounted_cash":1117.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT CDM","code_information":[{"code":"Px00045010046","type":"CDM"},{"code":"15005","type":"HCPCS"}],"standard_charges":[{"gross_charge":3103.0,"discounted_cash":2172.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUCTION BENIGN LESIONS UP TO 14 CDM","code_information":[{"code":"Px00045010047","type":"CDM"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION SINGLE TENDON ORIGIN/INSERTION CDM","code_information":[{"code":"Px00045010048","type":"CDM"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM","code_information":[{"code":"Px00045010049","type":"CDM"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM","code_information":[{"code":"Px00045010050","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ CDM","code_information":[{"code":"Px00045010051","type":"CDM"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION CDM","code_information":[{"code":"Px00045010052","type":"CDM"},{"code":"21453","type":"HCPCS"}],"standard_charges":[{"gross_charge":11414.0,"discounted_cash":7989.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG CDM","code_information":[{"code":"Px00045010053","type":"CDM"},{"code":"25608","type":"HCPCS"}],"standard_charges":[{"gross_charge":18191.0,"discounted_cash":12733.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG CDM","code_information":[{"code":"Px00045010054","type":"CDM"},{"code":"25609","type":"HCPCS"}],"standard_charges":[{"gross_charge":18191.0,"discounted_cash":12733.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERT CATH ARTERY CUTDOWN CDM","code_information":[{"code":"Px00045010055","type":"CDM"},{"code":"36625","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":209.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA CDM","code_information":[{"code":"Px00045010056","type":"CDM"},{"code":"26080","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER CDM","code_information":[{"code":"Px00045010057","type":"CDM"},{"code":"26235","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OSTEOTOMY PHALANX FINGER EACH CDM","code_information":[{"code":"Px00045010058","type":"CDM"},{"code":"26567","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE CDM","code_information":[{"code":"Px00045010059","type":"CDM"},{"code":"26607","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SUTURE INFRAPATELLAR TENDON PRIMARY CDM","code_information":[{"code":"Px00045010063","type":"CDM"},{"code":"27380","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE CDM","code_information":[{"code":"Px00045010064","type":"CDM"},{"code":"28525","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING HIP CDM","code_information":[{"code":"Px00045010065","type":"CDM"},{"code":"29520","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE CDM","code_information":[{"code":"Px00045010066","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CATHETER ASPIRATION NASOTRACHEAL SPX CDM","code_information":[{"code":"Px00045010067","type":"CDM"},{"code":"31720","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":287.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING CDM","code_information":[{"code":"Px00045010068","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH CDM","code_information":[{"code":"Px00045010071","type":"CDM"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":10911.0,"discounted_cash":7637.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RPR BLOOD VESSEL DIRECT LOWER EXTREMITY CDM","code_information":[{"code":"Px00045010073","type":"CDM"},{"code":"35226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.0,"discounted_cash":1192.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTRODUCTION NEEDLE/INTRACATHETER VEIN CDM","code_information":[{"code":"Px00045010074","type":"CDM"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM CDM","code_information":[{"code":"Px00045010076","type":"CDM"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1670.0,"discounted_cash":1169.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YRS OR MORE CDM","code_information":[{"code":"Px00045010077","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":1169.0,"discounted_cash":818.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YRS OR MORE CDM","code_information":[{"code":"Px00045010078","type":"CDM"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":6368.0,"discounted_cash":4457.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSJ PRPH CVC W/O SUBQ PORT/PMP UNDER 5 YR CDM","code_information":[{"code":"Px00045010079","type":"CDM"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":3181.0,"discounted_cash":2226.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YRS OR MORE CDM","code_information":[{"code":"Px00045010080","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":917.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE CDM","code_information":[{"code":"Px00045010081","type":"CDM"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH CDM","code_information":[{"code":"Px00045010082","type":"CDM"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX CDM","code_information":[{"code":"Px00045010083","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYSIS CEREBRAL IV INFUSION CDM","code_information":[{"code":"Px00045010084","type":"CDM"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":355.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE CDM","code_information":[{"code":"Px00045010086","type":"CDM"},{"code":"41007","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB CDM","code_information":[{"code":"Px00045010087","type":"CDM"},{"code":"41017","type":"HCPCS"}],"standard_charges":[{"gross_charge":6081.0,"discounted_cash":4256.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM","code_information":[{"code":"Px00045010088","type":"CDM"},{"code":"43239","type":"HCPCS"}],"standard_charges":[{"gross_charge":4343.0,"discounted_cash":3040.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYSIS CORONARY INTRAVENOUS INFUSION CDM","code_information":[{"code":"Px00045010089","type":"CDM"},{"code":"92977","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.0,"discounted_cash":476.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EGD FLEXIBLE FOREIGN BODY REMOVAL CDM","code_information":[{"code":"Px00045010090","type":"CDM"},{"code":"43247","type":"HCPCS"}],"standard_charges":[{"gross_charge":4343.0,"discounted_cash":3040.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE CDM","code_information":[{"code":"Px00045010091","type":"CDM"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":564.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO CDM","code_information":[{"code":"Px00045010092","type":"CDM"},{"code":"43761","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00045010093","type":"CDM"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1765.0,"discounted_cash":1235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CRITICAL CARE FIRST HOUR CDM","code_information":[{"code":"Px00045010094","type":"CDM"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1990.0,"discounted_cash":1393.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SIGMOIDOSCOPY FLX CONTROL BLEEDING CDM","code_information":[{"code":"Px00045010095","type":"CDM"},{"code":"45334","type":"HCPCS"}],"standard_charges":[{"gross_charge":2700.0,"discounted_cash":1890.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF RECTAL ABSCESS CDM","code_information":[{"code":"Px00045010097","type":"CDM"},{"code":"45005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2315.0,"discounted_cash":1620.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY DX CDM","code_information":[{"code":"Px00045010098","type":"CDM"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1054.0,"discounted_cash":737.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOSIGMOIDOSCOPY FB CDM","code_information":[{"code":"Px00045010099","type":"CDM"},{"code":"45307","type":"HCPCS"}],"standard_charges":[{"gross_charge":6408.0,"discounted_cash":4485.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REDUCTION OF RECTAL PROLAPSE CDM","code_information":[{"code":"Px00045010100","type":"CDM"},{"code":"45900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":1243.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM","code_information":[{"code":"Px00045010101","type":"CDM"},{"code":"45378","type":"HCPCS"}],"standard_charges":[{"gross_charge":2073.0,"discounted_cash":1451.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD CDM","code_information":[{"code":"Px00045010102","type":"CDM"},{"code":"45382","type":"HCPCS"}],"standard_charges":[{"gross_charge":2700.0,"discounted_cash":1890.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CYSTO W/SIMPLE REMOVAL STONE & STENT CDM","code_information":[{"code":"Px00045010103","type":"CDM"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":4626.0,"discounted_cash":3238.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM CDM","code_information":[{"code":"Px00045010104","type":"CDM"},{"code":"54435","type":"HCPCS"}],"standard_charges":[{"gross_charge":8814.0,"discounted_cash":6169.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX CDM","code_information":[{"code":"Px00045010105","type":"CDM"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA CDM","code_information":[{"code":"Px00045010106","type":"CDM"},{"code":"61108","type":"HCPCS"}],"standard_charges":[{"gross_charge":2495.0,"discounted_cash":1746.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM","code_information":[{"code":"Px00045010107","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID CDM","code_information":[{"code":"Px00045010108","type":"CDM"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":1108.0,"discounted_cash":775.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED MANIPULATE ELBOW W/ANESTH CDM","code_information":[{"code":"Px00045010109","type":"CDM"},{"code":"24300","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ALCOHOL/DRUG SCREEN/INTERVENTION 15-30 MIN CDM","code_information":[{"code":"Px00045010110","type":"CDM"},{"code":"99408","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ALCOHOL/DRUG SCREEN/INTERVENTION GT/30 MIN CDM","code_information":[{"code":"Px00045010111","type":"CDM"},{"code":"99409","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NASOPHARYNGOSCOPY CDM","code_information":[{"code":"Px00045010113","type":"CDM"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF MISCARRIAGE CDM","code_information":[{"code":"Px00045010115","type":"CDM"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EPISIOTOMY OR VAGINAL REPAIR CDM","code_information":[{"code":"Px00045010117","type":"CDM"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":6044.0,"discounted_cash":4230.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED VAGINAL DELIVERY ONLY CDM","code_information":[{"code":"Px00045010118","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":4236.0,"discounted_cash":2965.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DELIVER PLACENTA CDM","code_information":[{"code":"Px00045010119","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SPONTANEOUS ABORTION FAC CDM","code_information":[{"code":"Px00045010121","type":"CDM"},{"code":"59820","type":"HCPCS"}],"standard_charges":[{"gross_charge":6044.0,"discounted_cash":4230.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TEMP TRANSCUTANEOUS EXT PACING CDM","code_information":[{"code":"Px00045010123","type":"CDM"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":236.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SEXUAL ASSAULT EXAM CDM","code_information":[{"code":"Px00045010130","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.0,"discounted_cash":620.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS CDM","code_information":[{"code":"Px00045010132","type":"CDM"},{"code":"46221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":1243.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS CDM","code_information":[{"code":"Px00045010134","type":"CDM"},{"code":"46230","type":"HCPCS"}],"standard_charges":[{"gross_charge":5493.0,"discounted_cash":3845.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DISTAL RADIAL FRACTURE CDM","code_information":[{"code":"Px00045010138","type":"CDM"},{"code":"25606","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TX PELVIC FX W/O MANIP CDM","code_information":[{"code":"Px00045010139","type":"CDM"},{"code":"27197","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX PELVIC FX W/MANIP CDM","code_information":[{"code":"Px00045010140","type":"CDM"},{"code":"27198","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD DRAW LT 3 YRS FEM/JUGULAR CDM","code_information":[{"code":"Px00045010143","type":"CDM"},{"code":"36400","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD DRAW LT 3 YRS SCALP VEIN CDM","code_information":[{"code":"Px00045010144","type":"CDM"},{"code":"36405","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD DRAW LT 3 YRS OTHER VEIN CDM","code_information":[{"code":"Px00045010145","type":"CDM"},{"code":"36406","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NON-ROUTINE BL DRAW GT/3 YRS CDM","code_information":[{"code":"Px00045010146","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED VEIN ACCESS CUTDOWN LT/1 YR CDM","code_information":[{"code":"Px00045010148","type":"CDM"},{"code":"36420","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED VEIN ACCESS CUTDOWN GT/1 YR CDM","code_information":[{"code":"Px00045010149","type":"CDM"},{"code":"36425","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLSD CLAVICLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010152","type":"CDM"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CORRECT HALLUX VALGUS SESAMOID CDM","code_information":[{"code":"Px00045010154","type":"CDM"},{"code":"28295","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE WRIST TENDON LESION CDM","code_information":[{"code":"Px00045010156","type":"CDM"},{"code":"25111","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT THIGH FX GROWTH PLATE CDM","code_information":[{"code":"Px00045010157","type":"CDM"},{"code":"27516","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNEE FRACTURE(S) TUBEROSITY CDM","code_information":[{"code":"Px00045010158","type":"CDM"},{"code":"27538","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNEE DISLOCATION CDM","code_information":[{"code":"Px00045010159","type":"CDM"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT KNEE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010163","type":"CDM"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3945.0,"discounted_cash":2761.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT KNEE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010165","type":"CDM"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT PATELLA DISLOCATION W/ANSETH CDM","code_information":[{"code":"Px00045010168","type":"CDM"},{"code":"27562","type":"HCPCS"}],"standard_charges":[{"gross_charge":805.0,"discounted_cash":563.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN LOWER LEG LESION DEEP CDM","code_information":[{"code":"Px00045010171","type":"CDM"},{"code":"27603","type":"HCPCS"}],"standard_charges":[{"gross_charge":2231.0,"discounted_cash":1561.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN LOWER LEG BURSA CDM","code_information":[{"code":"Px00045010172","type":"CDM"},{"code":"27604","type":"HCPCS"}],"standard_charges":[{"gross_charge":6650.0,"discounted_cash":4655.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR ACHILLES TENDON CDM","code_information":[{"code":"Px00045010173","type":"CDM"},{"code":"27650","type":"HCPCS"}],"standard_charges":[{"gross_charge":18191.0,"discounted_cash":12733.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF LEG TENDON EACH CDM","code_information":[{"code":"Px00045010174","type":"CDM"},{"code":"27664","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TIB SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010176","type":"CDM"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TIBIAL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010179","type":"CDM"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":2750.0,"discounted_cash":1925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010182","type":"CDM"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010185","type":"CDM"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":2750.0,"discounted_cash":1925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE INT DWELL URETERAL STENT TRANSURETHRAL CDM","code_information":[{"code":"Px00045010186","type":"CDM"},{"code":"50386","type":"HCPCS"}],"standard_charges":[{"gross_charge":5101.0,"discounted_cash":3570.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE CDM","code_information":[{"code":"Px00045010187","type":"CDM"},{"code":"27766","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX POST ANKLE FX W/O MANIP CDM","code_information":[{"code":"Px00045010189","type":"CDM"},{"code":"27767","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX POST ANKLE FX W/MANIPULATION CDM","code_information":[{"code":"Px00045010190","type":"CDM"},{"code":"27768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PARTIAL EXCISION BONE PHALANX TOE CDM","code_information":[{"code":"Px00045010191","type":"CDM"},{"code":"28124","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF FIBULA FRACTURE PROX W/O MANIP CDM","code_information":[{"code":"Px00045010192","type":"CDM"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF FIBULA FRACTURE PROX W/MANIP CDM","code_information":[{"code":"Px00045010195","type":"CDM"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PARTIAL REMOVAL OF TOE-HEMIPHALANGECTOMY OR INTERPHALANGEA CDM","code_information":[{"code":"Px00045010196","type":"CDM"},{"code":"28160","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE CDM","code_information":[{"code":"Px00045010197","type":"CDM"},{"code":"27784","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010198","type":"CDM"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX CDM","code_information":[{"code":"Px00045010200","type":"CDM"},{"code":"51045","type":"HCPCS"}],"standard_charges":[{"gross_charge":5101.0,"discounted_cash":3570.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR CDM","code_information":[{"code":"Px00045010201","type":"CDM"},{"code":"63661","type":"HCPCS"}],"standard_charges":[{"gross_charge":4943.0,"discounted_cash":3460.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 1 CDM","code_information":[{"code":"Px00045010204","type":"CDM"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 2 CDM","code_information":[{"code":"Px00045010207","type":"CDM"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":237.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 3 CDM","code_information":[{"code":"Px00045010210","type":"CDM"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 4 CDM","code_information":[{"code":"Px00045010213","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.0,"discounted_cash":620.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FAC E&M VISIT LEVEL 5 CDM","code_information":[{"code":"Px00045010216","type":"CDM"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":1565.0,"discounted_cash":1095.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSJ NON-NDWELLG BLADDER CATHETER CDM","code_information":[{"code":"Px00045010219","type":"CDM"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CRITICAL CARE ADDL 30 MIN CDM","code_information":[{"code":"Px00045010221","type":"CDM"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.0,"discounted_cash":605.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE CDM","code_information":[{"code":"Px00045010223","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CHANGE CYSTOSTOMY TUBE SIMPLE CDM","code_information":[{"code":"Px00045010227","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CHANGE CYSTOSTOMY TUBE COMPLICATED CDM","code_information":[{"code":"Px00045010228","type":"CDM"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM","code_information":[{"code":"Px00045010229","type":"CDM"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOURETHROSCOPY CDM","code_information":[{"code":"Px00045010230","type":"CDM"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":1091.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX FINGER DISLOCATION CDM","code_information":[{"code":"Px00045010231","type":"CDM"},{"code":"26785","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX METATARSAL FXW W/O CDM","code_information":[{"code":"Px00045010232","type":"CDM"},{"code":"28485","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA CDM","code_information":[{"code":"Px00045010233","type":"CDM"},{"code":"25028","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CYSTO BLADDER W/URETERAL CATHETERIZATION CDM","code_information":[{"code":"Px00045010234","type":"CDM"},{"code":"52005","type":"HCPCS"}],"standard_charges":[{"gross_charge":4626.0,"discounted_cash":3238.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METACARPAL FRACTURE W/INTERNAL FIXATION CDM","code_information":[{"code":"Px00045010235","type":"CDM"},{"code":"26615","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION ANES AGENT SPHENOPALATINE GANGLION CDM","code_information":[{"code":"Px00045010236","type":"CDM"},{"code":"64505","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FUSION OF FINGER JOINT CDM","code_information":[{"code":"Px00045010238","type":"CDM"},{"code":"26860","type":"HCPCS"}],"standard_charges":[{"gross_charge":3677.0,"discounted_cash":2573.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED AMPUTATE FINGER/THUMB SINGLE W/DIRECT CLOSURE CDM","code_information":[{"code":"Px00045010239","type":"CDM"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":1534.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DILAT URETHRAL STRIX DILATOR MALE 1ST","code_information":[{"code":"Px00045010240","type":"CDM"},{"code":"53600","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":321.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LEV 1 HOSP TYPE B ED VISIT CDM","code_information":[{"code":"Px00045010241","type":"CDM"},{"code":"G0380","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SKIN FULL GRAFT EEN & LIPS 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010242","type":"CDM"},{"code":"15260","type":"HCPCS"}],"standard_charges":[{"gross_charge":4746.0,"discounted_cash":3322.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LEV 2 HOSP TYPE B ED VISIT CDM","code_information":[{"code":"Px00045010243","type":"CDM"},{"code":"G0381","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE","code_information":[{"code":"Px00045010244","type":"CDM"},{"code":"41008","type":"HCPCS"}],"standard_charges":[{"gross_charge":6081.0,"discounted_cash":4256.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC CDM","code_information":[{"code":"Px00045010245","type":"CDM"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERQ DILATION XST TRC ENDOUROLOGIC PX W/O IMG CDM","code_information":[{"code":"Px00045010246","type":"CDM"},{"code":"43763","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LEV 3 HOSP TYPE B ED VISIT CDM","code_information":[{"code":"Px00045010249","type":"CDM"},{"code":"G0382","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":324.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED AMPUTATE FINGER/THUMB SINGLE W/LOCAL ADV FLAPS CDM","code_information":[{"code":"Px00045010250","type":"CDM"},{"code":"26952","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":1534.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REAPPROXIMATING OF DISTAL FINGERTIP CDM","code_information":[{"code":"Px00045010251","type":"CDM"},{"code":"26989","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF PELVIS LESION CDM","code_information":[{"code":"Px00045010252","type":"CDM"},{"code":"26990","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE HIP FOREIGN BODY CDM","code_information":[{"code":"Px00045010254","type":"CDM"},{"code":"27087","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT COCCYGEAL FRACTURE CDM","code_information":[{"code":"Px00045010255","type":"CDM"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HIP SOCKET FRACTURE CDM","code_information":[{"code":"Px00045010256","type":"CDM"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TX THIGH FRACTURE PROX END NECK W/O MANIP CDM","code_information":[{"code":"Px00045010257","type":"CDM"},{"code":"27230","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ CDM","code_information":[{"code":"Px00045010258","type":"CDM"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX GREATER TROCHANTERIC FX W/O MANJ CDM","code_information":[{"code":"Px00045010259","type":"CDM"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LEV 4 HOSP TYPE B ED VISIT CDM","code_information":[{"code":"Px00045010261","type":"CDM"},{"code":"G0383","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.0,"discounted_cash":465.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX HIP DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010263","type":"CDM"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LEV 5 HOSP TYPE B ED VISIT CDM","code_information":[{"code":"Px00045010265","type":"CDM"},{"code":"G0384","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX HIP DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010267","type":"CDM"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":3660.0,"discounted_cash":2562.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TX SPONTANEOUS HIP DISLOCATION BY ABDUCTION W/O ANESTH W/O MANIP CDM","code_information":[{"code":"Px00045010269","type":"CDM"},{"code":"27256","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TX POST HIP ARTHROPLASTY DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010271","type":"CDM"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TX POST HIP ARTHROPLASTY DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010275","type":"CDM"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":1979.0,"discounted_cash":1385.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOREIGN BODY DEEP CDM","code_information":[{"code":"Px00045010276","type":"CDM"},{"code":"27086","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX THIGH FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010278","type":"CDM"},{"code":"27240","type":"HCPCS"}],"standard_charges":[{"gross_charge":4110.0,"discounted_cash":2877.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NEG PRESSURE WOUND THERAPY UTILIZING DME 50 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010279","type":"CDM"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX CDM","code_information":[{"code":"Px00045010280","type":"CDM"},{"code":"20650","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED RX ACETABULAR FX MANIPULATION CDM","code_information":[{"code":"Px00045010281","type":"CDM"},{"code":"27222","type":"HCPCS"}],"standard_charges":[{"gross_charge":2735.0,"discounted_cash":1914.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT CDM","code_information":[{"code":"Px00045010282","type":"CDM"},{"code":"62252","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":532.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE TENDON SHEATH DIGIT&/PALM EACH CDM","code_information":[{"code":"Px00045010283","type":"CDM"},{"code":"26020","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TX FINGER FRACTURE W/PERC FIXATION W/MANIP EACH CDM","code_information":[{"code":"Px00045010284","type":"CDM"},{"code":"26727","type":"HCPCS"}],"standard_charges":[{"gross_charge":3336.0,"discounted_cash":2335.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION CDM","code_information":[{"code":"Px00045010285","type":"CDM"},{"code":"27301","type":"HCPCS"}],"standard_charges":[{"gross_charge":2621.0,"discounted_cash":1834.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY DEEP THIGH/KNEE CDM","code_information":[{"code":"Px00045010286","type":"CDM"},{"code":"27372","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT FEMORAL SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010289","type":"CDM"},{"code":"27500","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI CDM","code_information":[{"code":"Px00045010290","type":"CDM"},{"code":"54430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1751.0,"discounted_cash":1225.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX OF LUNATE DISLOCATION CDM","code_information":[{"code":"Px00045010291","type":"CDM"},{"code":"25695","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF THIGH FRACTURE SUPRACNDLR W/O MANIP CDM","code_information":[{"code":"Px00045010292","type":"CDM"},{"code":"27501","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF THIGH FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010294","type":"CDM"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":3931.0,"discounted_cash":2751.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF THIGH FRACTURE W/WO TRACTION CDM","code_information":[{"code":"Px00045010295","type":"CDM"},{"code":"27503","type":"HCPCS"}],"standard_charges":[{"gross_charge":3945.0,"discounted_cash":2761.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FEMORAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010297","type":"CDM"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNEE FRACTURE PROXIMAL TIBIAL W/MANIP CDM","code_information":[{"code":"Px00045010299","type":"CDM"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":2443.0,"discounted_cash":1710.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NEUROPLASTY MEDIAN NERVE AT CARP TUNNEL CDM","code_information":[{"code":"Px00045010300","type":"CDM"},{"code":"64721","type":"HCPCS"}],"standard_charges":[{"gross_charge":3842.0,"discounted_cash":2689.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PLACEMENT SETON CDM","code_information":[{"code":"Px00045010301","type":"CDM"},{"code":"46020","type":"HCPCS"}],"standard_charges":[{"gross_charge":5493.0,"discounted_cash":3845.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REM PILONIDAL CYST EXTENSIVE CDM","code_information":[{"code":"Px00045010302","type":"CDM"},{"code":"11771","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ADJ TISS TRS S/A/L DEF 10SQCM CDM","code_information":[{"code":"Px00045010303","type":"CDM"},{"code":"14020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3689.0,"discounted_cash":2582.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APL SKIN SUB HI TAL 1ST 25CM CDM","code_information":[{"code":"Px00045010304","type":"CDM"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":4746.0,"discounted_cash":3322.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APL SKIN SUB HI TAL PED ADL100 CDM","code_information":[{"code":"Px00045010305","type":"CDM"},{"code":"15274","type":"HCPCS"}],"standard_charges":[{"gross_charge":1602.0,"discounted_cash":1121.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PEDICLE FLAP EL NOSE EAR LIPS CDM","code_information":[{"code":"Px00045010306","type":"CDM"},{"code":"15576","type":"HCPCS"}],"standard_charges":[{"gross_charge":4746.0,"discounted_cash":3322.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERT NON-TUNNEL CV CATH LT/5 YR CDM","code_information":[{"code":"Px00045010307","type":"CDM"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1412.0,"discounted_cash":988.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERT NEEDLE BONE CAVITY CDM","code_information":[{"code":"Px00045010308","type":"CDM"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM","code_information":[{"code":"Px00045010309","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SKIN ABSCESS COMPLICATED OR MULTIPLE CDM","code_information":[{"code":"Px00045010310","type":"CDM"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF PILONIDAL CYST SIMPLE CDM","code_information":[{"code":"Px00045010311","type":"CDM"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF PILONIDAL CYST COMPLICATED CDM","code_information":[{"code":"Px00045010312","type":"CDM"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1171.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY SIMPLE CDM","code_information":[{"code":"Px00045010313","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY COMPLICATED CDM","code_information":[{"code":"Px00045010314","type":"CDM"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":2167.0,"discounted_cash":1516.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FOREHEAD FLAP W VASC PEDICLE CDM","code_information":[{"code":"Px00045010315","type":"CDM"},{"code":"15731","type":"HCPCS"}],"standard_charges":[{"gross_charge":8946.0,"discounted_cash":6262.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF HEMA/FLUID CDM","code_information":[{"code":"Px00045010316","type":"CDM"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1171.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED COMPLEX DRAINAGE WOUND - CMPLX CDM","code_information":[{"code":"Px00045010317","type":"CDM"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":2621.0,"discounted_cash":1834.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE INFECTED SKIN CDM","code_information":[{"code":"Px00045010318","type":"CDM"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE INFECTED SKIN ADD-ON CDM","code_information":[{"code":"Px00045010319","type":"CDM"},{"code":"11001","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE SKIN AT FX SITE CDM","code_information":[{"code":"Px00045010320","type":"CDM"},{"code":"11010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEB SKIN BONE AT FX SITE CDM","code_information":[{"code":"Px00045010321","type":"CDM"},{"code":"11012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1472.0,"discounted_cash":1030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEB SUBQ TISSUE 20 SQ CM OR LESS - DEBRIDE SKIN CDM","code_information":[{"code":"Px00045010324","type":"CDM"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEB MUSC/FASCIA 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010325","type":"CDM"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TRACHEOSTOMY PLANNED SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00045010326","type":"CDM"},{"code":"31600","type":"HCPCS"}],"standard_charges":[{"gross_charge":7824.0,"discounted_cash":5476.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEB BONE 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010327","type":"CDM"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":1055.0,"discounted_cash":738.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT NASAL SEPTAL FRACTURE CDM","code_information":[{"code":"Px00045010328","type":"CDM"},{"code":"21337","type":"HCPCS"}],"standard_charges":[{"gross_charge":6081.0,"discounted_cash":4256.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEB MUSC/FASCIA ADD-ON CDM","code_information":[{"code":"Px00045010329","type":"CDM"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDEMENT BONE EACH ADDL 20 SQ CM","code_information":[{"code":"Px00045010330","type":"CDM"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":1055.0,"discounted_cash":738.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SKIN TAGS CDM","code_information":[{"code":"Px00045010331","type":"CDM"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE SKIN TAGS ADD-ON CDM","code_information":[{"code":"Px00045010332","type":"CDM"},{"code":"11201","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG CDM","code_information":[{"code":"Px00045010333","type":"CDM"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":557.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM CDM","code_information":[{"code":"Px00045010334","type":"CDM"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":389.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM CDM","code_information":[{"code":"Px00045010335","type":"CDM"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":2167.0,"discounted_cash":1516.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM OR LESS CDM","code_information":[{"code":"Px00045010336","type":"CDM"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1055.0,"discounted_cash":738.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM CDM","code_information":[{"code":"Px00045010337","type":"CDM"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":1055.0,"discounted_cash":738.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM CDM","code_information":[{"code":"Px00045010338","type":"CDM"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":1055.0,"discounted_cash":738.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM CDM","code_information":[{"code":"Px00045010344","type":"CDM"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":2167.0,"discounted_cash":1516.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM CDM","code_information":[{"code":"Px00045010345","type":"CDM"},{"code":"11424","type":"HCPCS"}],"standard_charges":[{"gross_charge":2167.0,"discounted_cash":1516.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE NAIL 1-5 CDM","code_information":[{"code":"Px00045010346","type":"CDM"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDE NAIL 6 OR MORE CDM","code_information":[{"code":"Px00045010347","type":"CDM"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF NAIL PLATE CDM","code_information":[{"code":"Px00045010348","type":"CDM"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE NAIL PLATE ADD-ON CDM","code_information":[{"code":"Px00045010349","type":"CDM"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF NAIL BED CDM","code_information":[{"code":"Px00045010351","type":"CDM"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":394.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF NAIL BED CDM","code_information":[{"code":"Px00045010353","type":"CDM"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION OF NAIL FOLD TOE CDM","code_information":[{"code":"Px00045010354","type":"CDM"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM","code_information":[{"code":"Px00045010355","type":"CDM"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WND(S) 2.6-7.5CM SLP NK AX EXGEN TRNK E CDM","code_information":[{"code":"Px00045010356","type":"CDM"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM CDM","code_information":[{"code":"Px00045010357","type":"CDM"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SPRFCL WOUND(S)12.6 TO 20.0CM SLP NK AX EXGEN TRNK EXTR H CDM","code_information":[{"code":"Px00045010358","type":"CDM"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SPRFCL WOUND(S) 20.1-30.0CM SLP NK AX EXGEN TRNK EXTR HND CDM","code_information":[{"code":"Px00045010359","type":"CDM"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S)GT/30CM SLP NK AX EXGEN TRNK EXTR CDM","code_information":[{"code":"Px00045010360","type":"CDM"},{"code":"12007","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":256.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) LT/2.5 FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010361","type":"CDM"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 2.6-5.0CM FACE ERS EYLD NSE LP CDM","code_information":[{"code":"Px00045010362","type":"CDM"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":136.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 5.1-7.5CM FACE ERS EYLD NSE LP CDM","code_information":[{"code":"Px00045010363","type":"CDM"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 7.6-12.5CM FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010364","type":"CDM"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":196.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 12.6-20.0CM FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010365","type":"CDM"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCISE EXCESSIVE SKN TISS OTHR CDM","code_information":[{"code":"Px00045010366","type":"CDM"},{"code":"15839","type":"HCPCS"}],"standard_charges":[{"gross_charge":7104.0,"discounted_cash":4972.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) 20.1-30.0CM FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010367","type":"CDM"},{"code":"12017","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":256.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR SUPERFICIAL WOUND(S) GT/30.0 CM FACE ERS EYLD NSE LPS MUC CDM","code_information":[{"code":"Px00045010369","type":"CDM"},{"code":"12018","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSURE OF SPLIT WOUND SIMPLE CLOSURE CDM","code_information":[{"code":"Px00045010370","type":"CDM"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSURE OF SPLIT WOUND W/PACKNG CDM","code_information":[{"code":"Px00045010371","type":"CDM"},{"code":"12021","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM","code_information":[{"code":"Px00045010372","type":"CDM"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00045010373","type":"CDM"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT 7.6 TO 12.5CM CDM","code_information":[{"code":"Px00045010374","type":"CDM"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":350.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00045010375","type":"CDM"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":380.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT 20.1 TO 30.0CM CDM","code_information":[{"code":"Px00045010376","type":"CDM"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":410.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR S/TR/EXT GT/30 CM CDM","code_information":[{"code":"Px00045010377","type":"CDM"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HF/GENIT UP TO 2.5CM CDM","code_information":[{"code":"Px00045010378","type":"CDM"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REM FIX DEV ANOTHER PHYSICIAN CDM","code_information":[{"code":"Px00045010379","type":"CDM"},{"code":"20665","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":564.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00045010380","type":"CDM"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT 7.6 TO 12.5CM CDM","code_information":[{"code":"Px00045010381","type":"CDM"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":350.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00045010382","type":"CDM"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":380.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT 20.1-30.0CM CDM","code_information":[{"code":"Px00045010383","type":"CDM"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":410.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR N-HG/GENIT GT/30.0CM CDM","code_information":[{"code":"Px00045010384","type":"CDM"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":440.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM LT/2.5 CM CDM","code_information":[{"code":"Px00045010385","type":"CDM"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM CDM","code_information":[{"code":"Px00045010386","type":"CDM"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":295.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM CDM","code_information":[{"code":"Px00045010387","type":"CDM"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 7.5 TO 12.5CM CDM","code_information":[{"code":"Px00045010388","type":"CDM"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00045010389","type":"CDM"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM 20.1 TO 30.0CM CDM","code_information":[{"code":"Px00045010390","type":"CDM"},{"code":"12056","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTMD WND REPAIR FACE/MM GT/30CM CDM","code_information":[{"code":"Px00045010391","type":"CDM"},{"code":"12057","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":319.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMPLEX TRUNK CDM","code_information":[{"code":"Px00045010392","type":"CDM"},{"code":"13100","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":443.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX TRUNK CDM","code_information":[{"code":"Px00045010393","type":"CDM"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":443.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR WOUND/LESION ADD-ON EA ADD 5CM COMPLEX TRUNK CDM","code_information":[{"code":"Px00045010394","type":"CDM"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMPLEX SCLP ARM LEG CDM","code_information":[{"code":"Px00045010395","type":"CDM"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX SCLP ARM LEG CDM","code_information":[{"code":"Px00045010396","type":"CDM"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":320.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REM EXTNL FIX DEV W ANES CDM","code_information":[{"code":"Px00045010397","type":"CDM"},{"code":"20694","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR WOUND/LESION ADD-ON 5CM OR LESS COMPLEX SCLP ARM LEG CDM","code_information":[{"code":"Px00045010398","type":"CDM"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM CDM","code_information":[{"code":"Px00045010399","type":"CDM"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT CDM","code_information":[{"code":"Px00045010401","type":"CDM"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SERIAL TONOMETRY EXAM(S) CDM","code_information":[{"code":"Px00045010402","type":"CDM"},{"code":"92100","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY CDM","code_information":[{"code":"Px00045010404","type":"CDM"},{"code":"33020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2326.0,"discounted_cash":1628.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE RECTAL OBSTRUCTION W GEN ANESTH CDM","code_information":[{"code":"Px00045010405","type":"CDM"},{"code":"45915","type":"HCPCS"}],"standard_charges":[{"gross_charge":2315.0,"discounted_cash":1620.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX CDM","code_information":[{"code":"Px00045010407","type":"CDM"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":3110.0,"discounted_cash":2177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF ANAL ABSCESS CDM","code_information":[{"code":"Px00045010409","type":"CDM"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.0,"discounted_cash":496.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCISE EXTERNAL HEMORRHOID CDM","code_information":[{"code":"Px00045010410","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE EXT HEM GROUPS 2 OR MORE CDM","code_information":[{"code":"Px00045010412","type":"CDM"},{"code":"46250","type":"HCPCS"}],"standard_charges":[{"gross_charge":5493.0,"discounted_cash":3845.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF HEMORRHOID CLOT CDM","code_information":[{"code":"Px00045010413","type":"CDM"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":3110.0,"discounted_cash":2177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045010414","type":"CDM"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ANOSCOPY REMOVE FOR BODY CDM","code_information":[{"code":"Px00045010415","type":"CDM"},{"code":"46608","type":"HCPCS"}],"standard_charges":[{"gross_charge":1054.0,"discounted_cash":737.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ANOSCOPY CONTROL BLEEDING CDM","code_information":[{"code":"Px00045010416","type":"CDM"},{"code":"46614","type":"HCPCS"}],"standard_charges":[{"gross_charge":1054.0,"discounted_cash":737.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE BY LIGAT INT HEM GRP CDM","code_information":[{"code":"Px00045010417","type":"CDM"},{"code":"46945","type":"HCPCS"}],"standard_charges":[{"gross_charge":3110.0,"discounted_cash":2177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSTOMY CYSTOTOMY W DRAINAGE CDM","code_information":[{"code":"Px00045010419","type":"CDM"},{"code":"51040","type":"HCPCS"}],"standard_charges":[{"gross_charge":5392.0,"discounted_cash":3774.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN BLADDER BY NEEDLE CDM","code_information":[{"code":"Px00045010420","type":"CDM"},{"code":"51100","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN BLADDER BY TROCAR/CATH CDM","code_information":[{"code":"Px00045010421","type":"CDM"},{"code":"51101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1397.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REV EYELID LAT CDM","code_information":[{"code":"Px00045010422","type":"CDM"},{"code":"21282","type":"HCPCS"}],"standard_charges":[{"gross_charge":7824.0,"discounted_cash":5476.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IRRIGATION OF BLADDER CDM","code_information":[{"code":"Px00045010423","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":331.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERT BLADDER CATH COMPLEX CDM","code_information":[{"code":"Px00045010424","type":"CDM"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TX FX ORBIT CLSD W MANIP CDM","code_information":[{"code":"Px00045010425","type":"CDM"},{"code":"21401","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY AND TREATMENT STRICTURE/DILATION CDM","code_information":[{"code":"Px00045010426","type":"CDM"},{"code":"52281","type":"HCPCS"}],"standard_charges":[{"gross_charge":4626.0,"discounted_cash":3238.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF URETHRA CDM","code_information":[{"code":"Px00045010427","type":"CDM"},{"code":"53020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3964.0,"discounted_cash":2774.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF URETHRA ABSCESS CDM","code_information":[{"code":"Px00045010428","type":"CDM"},{"code":"53060","type":"HCPCS"}],"standard_charges":[{"gross_charge":3964.0,"discounted_cash":2774.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CL TX PALTL/MAXLRY FX WID WFIX CDM","code_information":[{"code":"Px00045010429","type":"CDM"},{"code":"21421","type":"HCPCS"}],"standard_charges":[{"gross_charge":7824.0,"discounted_cash":5476.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DILATE URETHRA STRICTURE W/ FILIFORM MALE INITIAL CDM","code_information":[{"code":"Px00045010430","type":"CDM"},{"code":"53620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2606.0,"discounted_cash":1824.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DILATION OF URETHRA FEMALE INITIAL CDM","code_information":[{"code":"Px00045010431","type":"CDM"},{"code":"53660","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SLITTING OF PREPUCE EXCEPT NEWBORN CDM","code_information":[{"code":"Px00045010432","type":"CDM"},{"code":"54001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3964.0,"discounted_cash":2774.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM CDM","code_information":[{"code":"Px00045010433","type":"CDM"},{"code":"54220","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PREPUTIAL STRETCHING CDM","code_information":[{"code":"Px00045010434","type":"CDM"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":284.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REDUCE TESTIS TORSION CDM","code_information":[{"code":"Px00045010435","type":"CDM"},{"code":"54600","type":"HCPCS"}],"standard_charges":[{"gross_charge":8814.0,"discounted_cash":6169.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SCROTUM CDM","code_information":[{"code":"Px00045010436","type":"CDM"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":3964.0,"discounted_cash":2774.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF SCROTUM ABSCESS CDM","code_information":[{"code":"Px00045010437","type":"CDM"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1171.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SCROTUM LESION CDM","code_information":[{"code":"Px00045010438","type":"CDM"},{"code":"55120","type":"HCPCS"}],"standard_charges":[{"gross_charge":3964.0,"discounted_cash":2774.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED I & D OF VULVA/PERINEUM CDM","code_information":[{"code":"Px00045010440","type":"CDM"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF GLAND ABSCESS CDM","code_information":[{"code":"Px00045010441","type":"CDM"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SURGERY FOR VULVA LESION CDM","code_information":[{"code":"Px00045010442","type":"CDM"},{"code":"56440","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF PELVIC FLUID CDM","code_information":[{"code":"Px00045010443","type":"CDM"},{"code":"57020","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.0,"discounted_cash":602.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT VAGINAL BLEEDING CDM","code_information":[{"code":"Px00045010444","type":"CDM"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF VAGINA SUTURE CDM","code_information":[{"code":"Px00045010445","type":"CDM"},{"code":"57200","type":"HCPCS"}],"standard_charges":[{"gross_charge":4236.0,"discounted_cash":2965.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR VAGINA/PERINEUM CDM","code_information":[{"code":"Px00045010446","type":"CDM"},{"code":"57210","type":"HCPCS"}],"standard_charges":[{"gross_charge":7776.0,"discounted_cash":5443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PELVIC EXAMINATION CDM","code_information":[{"code":"Px00045010447","type":"CDM"},{"code":"57410","type":"HCPCS"}],"standard_charges":[{"gross_charge":6044.0,"discounted_cash":4230.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE VAGINAL FOREIGN BODY CDM","code_information":[{"code":"Px00045010448","type":"CDM"},{"code":"57415","type":"HCPCS"}],"standard_charges":[{"gross_charge":7776.0,"discounted_cash":5443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF EARDRUM W/O GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00045010450","type":"CDM"},{"code":"69420","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":277.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY OF CERVIX CDM","code_information":[{"code":"Px00045010451","type":"CDM"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.0,"discounted_cash":1052.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CAUTERIZATION OF CERVIX CDM","code_information":[{"code":"Px00045010452","type":"CDM"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2459.0,"discounted_cash":1721.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCSN EXTNSOR TNDN SHEATH WRST CDM","code_information":[{"code":"Px00045010453","type":"CDM"},{"code":"25000","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DILATION AND CURETTAGE CDM","code_information":[{"code":"Px00045010454","type":"CDM"},{"code":"58120","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE INTRAUTERINE DEVICE CDM","code_information":[{"code":"Px00045010455","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRILL SKULL FOR IMPLANTATION CDM","code_information":[{"code":"Px00045010456","type":"CDM"},{"code":"61107","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.0,"discounted_cash":585.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PIERCE SKULL & REMOVE CLOT CDM","code_information":[{"code":"Px00045010457","type":"CDM"},{"code":"61154","type":"HCPCS"}],"standard_charges":[{"gross_charge":3500.0,"discounted_cash":2450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PIERCE SKULL IMPLANT DEVICE CDM","code_information":[{"code":"Px00045010458","type":"CDM"},{"code":"61210","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.0,"discounted_cash":688.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ TRIGEMINAL CDM","code_information":[{"code":"Px00045010459","type":"CDM"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ OCCIPITAL CDM","code_information":[{"code":"Px00045010461","type":"CDM"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ INTERCOSTAL SINGLE CDM","code_information":[{"code":"Px00045010462","type":"CDM"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REV FNGR JNT EA CDM","code_information":[{"code":"Px00045010463","type":"CDM"},{"code":"26140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REM IMPLANT FINGER OR HAND CDM","code_information":[{"code":"Px00045010464","type":"CDM"},{"code":"26320","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ PLANTAR DIGIT CDM","code_information":[{"code":"Px00045010465","type":"CDM"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF DIGIT NERVE CDM","code_information":[{"code":"Px00045010466","type":"CDM"},{"code":"64831","type":"HCPCS"}],"standard_charges":[{"gross_charge":4703.0,"discounted_cash":3292.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE SUPERFICIAL CDM","code_information":[{"code":"Px00045010467","type":"CDM"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE EMBEDDED CDM","code_information":[{"code":"Px00045010469","type":"CDM"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":924.0,"discounted_cash":646.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE CORNEAL W/O SLIT LAMP CDM","code_information":[{"code":"Px00045010471","type":"CDM"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF EYE WOUND CDM","code_information":[{"code":"Px00045010474","type":"CDM"},{"code":"65270","type":"HCPCS"}],"standard_charges":[{"gross_charge":6105.0,"discounted_cash":4273.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CURETTE/TREAT CORNEA CDM","code_information":[{"code":"Px00045010475","type":"CDM"},{"code":"65435","type":"HCPCS"}],"standard_charges":[{"gross_charge":1870.0,"discounted_cash":1309.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CURETTE/TREAT CORNEA W/ APPLICATION OF CHELATING AGENT CDM","code_information":[{"code":"Px00045010477","type":"CDM"},{"code":"65436","type":"HCPCS"}],"standard_charges":[{"gross_charge":6105.0,"discounted_cash":4273.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REVISION OF CORNEA CDM","code_information":[{"code":"Px00045010479","type":"CDM"},{"code":"65600","type":"HCPCS"}],"standard_charges":[{"gross_charge":4345.0,"discounted_cash":3041.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REVISE EYE SOCKET IMPLANT CDM","code_information":[{"code":"Px00045010480","type":"CDM"},{"code":"67560","type":"HCPCS"}],"standard_charges":[{"gross_charge":10094.0,"discounted_cash":7065.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF EYELID ABSCESS CDM","code_information":[{"code":"Px00045010482","type":"CDM"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF EYELID FOLD CDM","code_information":[{"code":"Px00045010483","type":"CDM"},{"code":"67715","type":"HCPCS"}],"standard_charges":[{"gross_charge":6105.0,"discounted_cash":4273.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE EYELID FOREIGN BODY CDM","code_information":[{"code":"Px00045010484","type":"CDM"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":322.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN EXTERNAL EAR LESION SIMPLE CDM","code_information":[{"code":"Px00045010485","type":"CDM"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN EXTERNAL EAR LESION COMPLICATED CDM","code_information":[{"code":"Px00045010487","type":"CDM"},{"code":"69005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2621.0,"discounted_cash":1834.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLEAR OUTER EAR CANAL W/O GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00045010489","type":"CDM"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM","code_information":[{"code":"Px00045010491","type":"CDM"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF GUM LESION CDM","code_information":[{"code":"Px00045010492","type":"CDM"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION FEMORAL CDM","code_information":[{"code":"Px00045010493","type":"CDM"},{"code":"27509","type":"HCPCS"}],"standard_charges":[{"gross_charge":5196.0,"discounted_cash":3637.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT OF DISTAL END FEMOR FRACTURE CDM","code_information":[{"code":"Px00045010494","type":"CDM"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":731.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT PATELLAR FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010496","type":"CDM"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REP ET HAND W FG EA TENDON CDM","code_information":[{"code":"Px00045010497","type":"CDM"},{"code":"26412","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DECOMP ANT LAT LEG ONLY CDM","code_information":[{"code":"Px00045010498","type":"CDM"},{"code":"27600","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TIBIAL FRACTURE PROXIMAL W/O MANIP CDM","code_information":[{"code":"Px00045010499","type":"CDM"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND/LESION 2.6-7.5CM CMPLX FRHD CKS SHN MTH NK AX CDM","code_information":[{"code":"Px00045010501","type":"CDM"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":443.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR WND/LESION ADD-ON 5CM CMPLX FRHD CKS SHN MTH NK AX GEN HND CDM","code_information":[{"code":"Px00045010502","type":"CDM"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX EYLD NS ERS LIP CDM","code_information":[{"code":"Px00045010504","type":"CDM"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":443.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX EYLD NS ERS LIP CDM","code_information":[{"code":"Px00045010505","type":"CDM"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":473.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR WOUND/LESION ADD-ON 5CM CMPLX EYLD NS ERS LIP CDM","code_information":[{"code":"Px00045010506","type":"CDM"},{"code":"13153","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LATE CLOSURE OF WOUND EXTENSIVE OR COMPLICATED CDM","code_information":[{"code":"Px00045010507","type":"CDM"},{"code":"13160","type":"HCPCS"}],"standard_charges":[{"gross_charge":3689.0,"discounted_cash":2582.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTRAVITREAL NJX PHARMACOLOGIC AGT SPX CDM","code_information":[{"code":"Px00045010508","type":"CDM"},{"code":"67028","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.0,"discounted_cash":672.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM OR LESS CDM","code_information":[{"code":"Px00045010509","type":"CDM"},{"code":"14040","type":"HCPCS"}],"standard_charges":[{"gross_charge":3051.0,"discounted_cash":2135.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SKIN TISSUE REARRANGEMENT 10 SQ CM OR LESS EYLDS NS ERS LIP CDM","code_information":[{"code":"Px00045010510","type":"CDM"},{"code":"14060","type":"HCPCS"}],"standard_charges":[{"gross_charge":3051.0,"discounted_cash":2135.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FILLETED FINGER/TOE FLAP CDM","code_information":[{"code":"Px00045010511","type":"CDM"},{"code":"14350","type":"HCPCS"}],"standard_charges":[{"gross_charge":3689.0,"discounted_cash":2582.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SKIN PINCH GRAFT 2 CM DIAMETER CDM","code_information":[{"code":"Px00045010512","type":"CDM"},{"code":"15050","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SKN SPLT A-GRFT FAC/NCK/HF/G 1ST 100 SQ CM CDM","code_information":[{"code":"Px00045010513","type":"CDM"},{"code":"15120","type":"HCPCS"}],"standard_charges":[{"gross_charge":8946.0,"discounted_cash":6262.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010514","type":"CDM"},{"code":"15240","type":"HCPCS"}],"standard_charges":[{"gross_charge":3436.0,"discounted_cash":2405.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED COMPOSITE SKIN GRAFT EAR NASAL ALA CDM","code_information":[{"code":"Px00045010515","type":"CDM"},{"code":"15760","type":"HCPCS"}],"standard_charges":[{"gross_charge":4377.0,"discounted_cash":3063.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DERMA-FAT-FASCIA GRAFT CDM","code_information":[{"code":"Px00045010516","type":"CDM"},{"code":"15770","type":"HCPCS"}],"standard_charges":[{"gross_charge":8946.0,"discounted_cash":6262.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BIOPSY BONE OPEN SUPERFICIAL CDM","code_information":[{"code":"Px00045010517","type":"CDM"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INITIAL TREATMENT OF BURN(S) 1ST DEG LOCAL TX CDM","code_information":[{"code":"Px00045010518","type":"CDM"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRESS/DEBRID P-THICK BURN S LT/5% TBSA CDM","code_information":[{"code":"Px00045010519","type":"CDM"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRESS/DEBRID P-THICK BURN M 5-10% TBSA CDM","code_information":[{"code":"Px00045010520","type":"CDM"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRESS/DEBRID P-THICK BURN L GT/10% TBSA CDM","code_information":[{"code":"Px00045010521","type":"CDM"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF BURN SCAB INITI CDM","code_information":[{"code":"Px00045010522","type":"CDM"},{"code":"16035","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRESSING CHANGE UNDER ANESTHESIA CDM","code_information":[{"code":"Px00045010523","type":"CDM"},{"code":"15852","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":868.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUCTION OF SKIN LESIONS LESS THAN 10 SQ CM CDM","code_information":[{"code":"Px00045010524","type":"CDM"},{"code":"17106","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":557.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CHEMICAL CAUTERY TISSUE CDM","code_information":[{"code":"Px00045010525","type":"CDM"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCISION OF BREAST LESION CDM","code_information":[{"code":"Px00045010527","type":"CDM"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2621.0,"discounted_cash":1834.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND NECK CDM","code_information":[{"code":"Px00045010530","type":"CDM"},{"code":"20100","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND CHEST CDM","code_information":[{"code":"Px00045010531","type":"CDM"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":2719.0,"discounted_cash":1903.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND ABDOMEN CDM","code_information":[{"code":"Px00045010532","type":"CDM"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":2719.0,"discounted_cash":1903.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE WOUND EXTREMITY CDM","code_information":[{"code":"Px00045010533","type":"CDM"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1171.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOREIGN BODY MUSC SIMP CDM","code_information":[{"code":"Px00045010534","type":"CDM"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":394.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00045010535","type":"CDM"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED THER INJECTION CARP TUNNEL CDM","code_information":[{"code":"Px00045010536","type":"CDM"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":406.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJ TENDON SHEATH/LIGAMENT CDM","code_information":[{"code":"Px00045010538","type":"CDM"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJ TRIGGER POINT 1/2 MUSCL CDM","code_information":[{"code":"Px00045010539","type":"CDM"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION SINGLE/MLT TRIGGER POINT 3/GT MUSCLES CDM","code_information":[{"code":"Px00045010540","type":"CDM"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLY/REMOVE FIXATION DEVICE CRANIAL CDM","code_information":[{"code":"Px00045010541","type":"CDM"},{"code":"20660","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF HEAD BRACE CDM","code_information":[{"code":"Px00045010542","type":"CDM"},{"code":"20661","type":"HCPCS"}],"standard_charges":[{"gross_charge":1442.0,"discounted_cash":1009.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SUPPORT IMPLANT CDM","code_information":[{"code":"Px00045010543","type":"CDM"},{"code":"20670","type":"HCPCS"}],"standard_charges":[{"gross_charge":2167.0,"discounted_cash":1516.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FLUID PRESSURE MUSCLE CDM","code_information":[{"code":"Px00045010544","type":"CDM"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE SHOULDER FOREIGN BODY CDM","code_information":[{"code":"Px00045010546","type":"CDM"},{"code":"23330","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF NOSE FRACTURE W/ STABILIZATION CDM","code_information":[{"code":"Px00045010547","type":"CDM"},{"code":"21320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.0,"discounted_cash":1505.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT OF NOSE FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010548","type":"CDM"},{"code":"21325","type":"HCPCS"}],"standard_charges":[{"gross_charge":6081.0,"discounted_cash":4256.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT NASAL SEPTAL FRACTURE W/WO STABILIZATION CDM","code_information":[{"code":"Px00045010549","type":"CDM"},{"code":"21336","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION CDM","code_information":[{"code":"Px00045010550","type":"CDM"},{"code":"21400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1071.0,"discounted_cash":749.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT DENTAL RIDGE FRACTURE CDM","code_information":[{"code":"Px00045010552","type":"CDM"},{"code":"21440","type":"HCPCS"}],"standard_charges":[{"gross_charge":7824.0,"discounted_cash":5476.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT DENTAL RIDGE FRACTURE CDM","code_information":[{"code":"Px00045010553","type":"CDM"},{"code":"21445","type":"HCPCS"}],"standard_charges":[{"gross_charge":14684.0,"discounted_cash":10278.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT LOWER JAW FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010554","type":"CDM"},{"code":"21450","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":277.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT LOWER JAW FRACTURE W/ MANIPULATION CDM","code_information":[{"code":"Px00045010555","type":"CDM"},{"code":"21451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RESET DISLOCATED JAW UNCOMPLICATED CDM","code_information":[{"code":"Px00045010556","type":"CDM"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN NECK/CHEST LESION - LESION DRAIN CDM","code_information":[{"code":"Px00045010557","type":"CDM"},{"code":"21501","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT STERNUM FRACTURE CDM","code_information":[{"code":"Px00045010560","type":"CDM"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SPINE FRACTURE CDM","code_information":[{"code":"Px00045010562","type":"CDM"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN SHOULDER LESION CDM","code_information":[{"code":"Px00045010563","type":"CDM"},{"code":"23030","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC CDM","code_information":[{"code":"Px00045010564","type":"CDM"},{"code":"11011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045010566","type":"CDM"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM CDM","code_information":[{"code":"Px00045010568","type":"CDM"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":527.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX CLAVICULAR FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010569","type":"CDM"},{"code":"23505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2443.0,"discounted_cash":1710.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TANGENTIAL BIOPSY SKIN SINGLE LESION CDM","code_information":[{"code":"Px00045010571","type":"CDM"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLAVICLE DISLOCATION W/O MANI CDM","code_information":[{"code":"Px00045010572","type":"CDM"},{"code":"23520","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLAVICLE DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010574","type":"CDM"},{"code":"23525","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLAVICLE DISLOCATIONAC JT DISLO W/O MAN CDM","code_information":[{"code":"Px00045010576","type":"CDM"},{"code":"23540","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION CDM","code_information":[{"code":"Px00045010578","type":"CDM"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CLAVICLE DISLOCATION AC JT DISLO W/MAN CDM","code_information":[{"code":"Px00045010579","type":"CDM"},{"code":"23545","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SHOULDER BLADE FX W/O MANIP CDM","code_information":[{"code":"Px00045010581","type":"CDM"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SHOULDER BLADE FX W/MANIP CDM","code_information":[{"code":"Px00045010583","type":"CDM"},{"code":"23575","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010585","type":"CDM"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PUNCH BIOPSY SKIN SINGLE LESION CDM","code_information":[{"code":"Px00045010587","type":"CDM"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":557.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010588","type":"CDM"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2443.0,"discounted_cash":1710.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE TUBEROSITY W/O MAN CDM","code_information":[{"code":"Px00045010590","type":"CDM"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE TUBEROSITY W/MAN CDM","code_information":[{"code":"Px00045010592","type":"CDM"},{"code":"23625","type":"HCPCS"}],"standard_charges":[{"gross_charge":2443.0,"discounted_cash":1710.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SHOULDER DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010594","type":"CDM"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SHOULDER DISLOCATION W/MANIP & ANNES CDM","code_information":[{"code":"Px00045010596","type":"CDM"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":1828.0,"discounted_cash":1279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ CDM","code_information":[{"code":"Px00045010598","type":"CDM"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT DISLOCATION/FRACTURE W/SURG NK FX CDM","code_information":[{"code":"Px00045010600","type":"CDM"},{"code":"23675","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SHOULDER SURGERY PROCEDURE CDM","code_information":[{"code":"Px00045010601","type":"CDM"},{"code":"23929","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF ARM LESION CDM","code_information":[{"code":"Px00045010602","type":"CDM"},{"code":"23930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2621.0,"discounted_cash":1834.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF ARM BURSA CDM","code_information":[{"code":"Px00045010604","type":"CDM"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":4220.0,"discounted_cash":2954.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF ARM FOREIGN BODY CDM","code_information":[{"code":"Px00045010606","type":"CDM"},{"code":"24200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUCT PREMALG LESION FIRST LESION CDM","code_information":[{"code":"Px00045010608","type":"CDM"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN BLOOD FROM UNDER NAIL CDM","code_information":[{"code":"Px00045010609","type":"CDM"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF BREAST IMPLANT CDM","code_information":[{"code":"Px00045010610","type":"CDM"},{"code":"19328","type":"HCPCS"}],"standard_charges":[{"gross_charge":9454.0,"discounted_cash":6617.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION CDM","code_information":[{"code":"Px00045010611","type":"CDM"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF NOSE FRACTURE W/O STABILIZATION CDM","code_information":[{"code":"Px00045010612","type":"CDM"},{"code":"21315","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.0,"discounted_cash":1505.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NERVE BLOCK INJ ILIOINGUINAL CDM","code_information":[{"code":"Px00045010617","type":"CDM"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF CONTRACEPTIVE CAP CDM","code_information":[{"code":"Px00045010618","type":"CDM"},{"code":"11976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF SUPPORT IMPLANT CDM","code_information":[{"code":"Px00045010619","type":"CDM"},{"code":"20680","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR MUSCLES OF HAND CDM","code_information":[{"code":"Px00045010620","type":"CDM"},{"code":"26591","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNUCKLE DISLOCATION CDM","code_information":[{"code":"Px00045010621","type":"CDM"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":2468.0,"discounted_cash":1727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HIP DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010622","type":"CDM"},{"code":"27257","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORATION OF KNEE JOINT CDM","code_information":[{"code":"Px00045010623","type":"CDM"},{"code":"27310","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF FIGURE EIGHT CDM","code_information":[{"code":"Px00045010624","type":"CDM"},{"code":"29049","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR BLOOD VESSEL LESION CDM","code_information":[{"code":"Px00045010626","type":"CDM"},{"code":"35188","type":"HCPCS"}],"standard_charges":[{"gross_charge":14840.0,"discounted_cash":10388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EYELID WOUND CDM","code_information":[{"code":"Px00045010627","type":"CDM"},{"code":"67930","type":"HCPCS"}],"standard_charges":[{"gross_charge":6105.0,"discounted_cash":4273.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION EPIDURAL BLOOD/CLOT PATCH CDM","code_information":[{"code":"Px00045010629","type":"CDM"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES CDM","code_information":[{"code":"Px00045010631","type":"CDM"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":952.0,"discounted_cash":666.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010632","type":"CDM"},{"code":"23615","type":"HCPCS"}],"standard_charges":[{"gross_charge":35882.0,"discounted_cash":25117.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ELBOW FRACTURE CDM","code_information":[{"code":"Px00045010633","type":"CDM"},{"code":"24635","type":"HCPCS"}],"standard_charges":[{"gross_charge":18191.0,"discounted_cash":12733.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF ULNA CDM","code_information":[{"code":"Px00045010634","type":"CDM"},{"code":"25545","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FX RAD EXTRA-ARTICUL CDM","code_information":[{"code":"Px00045010635","type":"CDM"},{"code":"25607","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FINGER/HAND TENDON CDM","code_information":[{"code":"Px00045010636","type":"CDM"},{"code":"26350","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED HAND TENDON RECONSTRUCTION CDM","code_information":[{"code":"Px00045010637","type":"CDM"},{"code":"26502","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS CDM","code_information":[{"code":"Px00045010638","type":"CDM"},{"code":"27792","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX BIMALLEOLAR ANKLE FRACTURE CDM","code_information":[{"code":"Px00045010639","type":"CDM"},{"code":"27814","type":"HCPCS"}],"standard_charges":[{"gross_charge":18191.0,"discounted_cash":12733.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX TRIMALLEOLAR ANKLE FX WO FIX PST LIP CDM","code_information":[{"code":"Px00045010640","type":"CDM"},{"code":"27822","type":"HCPCS"}],"standard_charges":[{"gross_charge":18191.0,"discounted_cash":12733.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CORRECTION OF BUNION CDM","code_information":[{"code":"Px00045010641","type":"CDM"},{"code":"28296","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL THROAT BLEEDING CDM","code_information":[{"code":"Px00045010642","type":"CDM"},{"code":"42962","type":"HCPCS"}],"standard_charges":[{"gross_charge":7824.0,"discounted_cash":5476.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE ANAL FIST INTER CDM","code_information":[{"code":"Px00045010644","type":"CDM"},{"code":"46275","type":"HCPCS"}],"standard_charges":[{"gross_charge":5493.0,"discounted_cash":3845.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED HEMORRHOIDOPEXY BY STAPLING CDM","code_information":[{"code":"Px00045010645","type":"CDM"},{"code":"46947","type":"HCPCS"}],"standard_charges":[{"gross_charge":5493.0,"discounted_cash":3845.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LAPARO CHOLECYSTECTOMY/GRAPH CDM","code_information":[{"code":"Px00045010647","type":"CDM"},{"code":"47563","type":"HCPCS"}],"standard_charges":[{"gross_charge":14333.0,"discounted_cash":10033.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY REMOVAL OF CLOTS CDM","code_information":[{"code":"Px00045010648","type":"CDM"},{"code":"52001","type":"HCPCS"}],"standard_charges":[{"gross_charge":7993.0,"discounted_cash":5595.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CYSTOSCOPY AND TREATMENT CDM","code_information":[{"code":"Px00045010649","type":"CDM"},{"code":"52214","type":"HCPCS"}],"standard_charges":[{"gross_charge":7993.0,"discounted_cash":5595.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REVISION OF CERVIX 57720 CDM","code_information":[{"code":"Px00045010650","type":"CDM"},{"code":"57720","type":"HCPCS"}],"standard_charges":[{"gross_charge":6044.0,"discounted_cash":4230.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE SHOULDER FB DEEP CDM","code_information":[{"code":"Px00045010656","type":"CDM"},{"code":"23333","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF NASAL SEPTUM CDM","code_information":[{"code":"Px00045010659","type":"CDM"},{"code":"30520","type":"HCPCS"}],"standard_charges":[{"gross_charge":6081.0,"discounted_cash":4256.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL SUTURES/STAPLES REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00045010660","type":"CDM"},{"code":"15851","type":"HCPCS"}],"standard_charges":[{"gross_charge":3689.0,"discounted_cash":2582.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR ARM/LEG NERVE CDM","code_information":[{"code":"Px00045010661","type":"CDM"},{"code":"64857","type":"HCPCS"}],"standard_charges":[{"gross_charge":16992.0,"discounted_cash":11894.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE CDM","code_information":[{"code":"Px00045010662","type":"CDM"},{"code":"65235","type":"HCPCS"}],"standard_charges":[{"gross_charge":6236.0,"discounted_cash":4365.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF EYE CDM","code_information":[{"code":"Px00045010663","type":"CDM"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":6236.0,"discounted_cash":4365.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EYE EXAM NEW PATIENT CDM","code_information":[{"code":"Px00045010664","type":"CDM"},{"code":"92002","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED HYMENOTOMY SIMPLE INCISION CDM","code_information":[{"code":"Px00045010665","type":"CDM"},{"code":"56442","type":"HCPCS"}],"standard_charges":[{"gross_charge":7776.0,"discounted_cash":5443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RECONSTRUCTION OF NAIL BED W/GRAFT CDM","code_information":[{"code":"Px00045010667","type":"CDM"},{"code":"11762","type":"HCPCS"}],"standard_charges":[{"gross_charge":3689.0,"discounted_cash":2582.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE ANAL FIST SUBQ CDM","code_information":[{"code":"Px00045010668","type":"CDM"},{"code":"46270","type":"HCPCS"}],"standard_charges":[{"gross_charge":5493.0,"discounted_cash":3845.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF TIBIA FRACTURE CDM","code_information":[{"code":"Px00045010669","type":"CDM"},{"code":"27756","type":"HCPCS"}],"standard_charges":[{"gross_charge":18191.0,"discounted_cash":12733.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED MNPJ OF TMJ W/ANESTH CDM","code_information":[{"code":"Px00045010670","type":"CDM"},{"code":"21073","type":"HCPCS"}],"standard_charges":[{"gross_charge":3817.0,"discounted_cash":2671.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX VERT FX W/MANJ CDM","code_information":[{"code":"Px00045010671","type":"CDM"},{"code":"22315","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN CDM","code_information":[{"code":"Px00045010673","type":"CDM"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FOREARM TENDON/MUSCLE SECONDARY CDM","code_information":[{"code":"Px00045010674","type":"CDM"},{"code":"25263","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPLANTATION DIGIT COMPLETE CDM","code_information":[{"code":"Px00045010675","type":"CDM"},{"code":"20822","type":"HCPCS"}],"standard_charges":[{"gross_charge":3945.0,"discounted_cash":2761.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED HYPOTHERMIA ILL NEONATE CDM","code_information":[{"code":"Px00045010676","type":"CDM"},{"code":"99184","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":319.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EYELID WOUND FULL THICKNESS CDM","code_information":[{"code":"Px00045010677","type":"CDM"},{"code":"67935","type":"HCPCS"}],"standard_charges":[{"gross_charge":6105.0,"discounted_cash":4273.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE IMPACTED EAR WAX UNI CDM","code_information":[{"code":"Px00045010678","type":"CDM"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF SHOULDER CAST-PLASTER CDM","code_information":[{"code":"Px00045010679","type":"CDM"},{"code":"29058","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BLOOD PUSH TRANSFUSE LT 2 YR CDM","code_information":[{"code":"Px00045010680","type":"CDM"},{"code":"36440","type":"HCPCS"}],"standard_charges":[{"gross_charge":871.0,"discounted_cash":609.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANI CDM","code_information":[{"code":"Px00045010681","type":"CDM"},{"code":"27267","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF MOUTH LESION CDM","code_information":[{"code":"Px00045010682","type":"CDM"},{"code":"41015","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY W/OPER SCOPE CDM","code_information":[{"code":"Px00045010683","type":"CDM"},{"code":"31526","type":"HCPCS"}],"standard_charges":[{"gross_charge":3986.0,"discounted_cash":2790.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ESCHAROTOMY ADDL INCISION CDM","code_information":[{"code":"Px00045010684","type":"CDM"},{"code":"16036","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORE/REPAIR CHEST CDM","code_information":[{"code":"Px00045010685","type":"CDM"},{"code":"32110","type":"HCPCS"}],"standard_charges":[{"gross_charge":5464.0,"discounted_cash":3824.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCISE/DRAIN TEAR GLAND CDM","code_information":[{"code":"Px00045010686","type":"CDM"},{"code":"68400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2520.0,"discounted_cash":1764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LIGATION OF NECK ARTERY CDM","code_information":[{"code":"Px00045010687","type":"CDM"},{"code":"37615","type":"HCPCS"}],"standard_charges":[{"gross_charge":8601.0,"discounted_cash":6020.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PARTIAL REMOVAL FINGER BONE CDM","code_information":[{"code":"Px00045010688","type":"CDM"},{"code":"26236","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FINGER/HAND TENDON NO MAN LND-PRIMARY CDM","code_information":[{"code":"Px00045010689","type":"CDM"},{"code":"26356","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR PALATE CDM","code_information":[{"code":"Px00045010690","type":"CDM"},{"code":"42182","type":"HCPCS"}],"standard_charges":[{"gross_charge":11414.0,"discounted_cash":7989.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REVISE FINGER JOINT CDM","code_information":[{"code":"Px00045010691","type":"CDM"},{"code":"26535","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METACARPAL FRACTURE-PERC SK FIXATION CDM","code_information":[{"code":"Px00045010692","type":"CDM"},{"code":"26608","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT THIGH FRACTURE-CLS FEM NCK W/MAN CDM","code_information":[{"code":"Px00045010693","type":"CDM"},{"code":"27232","type":"HCPCS"}],"standard_charges":[{"gross_charge":5286.0,"discounted_cash":3700.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF MISCARRIAGE-2ND TRIM CDM","code_information":[{"code":"Px00045010694","type":"CDM"},{"code":"59821","type":"HCPCS"}],"standard_charges":[{"gross_charge":6044.0,"discounted_cash":4230.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SKIN TISSUE REARRANGEMENT 10.1 SQ CM TO 30.0 SQ CM FRHD CK CDM","code_information":[{"code":"Px00045010695","type":"CDM"},{"code":"14041","type":"HCPCS"}],"standard_charges":[{"gross_charge":4746.0,"discounted_cash":3322.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCISIONAL BIOPSY SKIN SINGLE LESION CDM","code_information":[{"code":"Px00045010696","type":"CDM"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":868.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION CDM","code_information":[{"code":"Px00045010697","type":"CDM"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS CDM","code_information":[{"code":"Px00045010698","type":"CDM"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM CDM","code_information":[{"code":"Px00045010699","type":"CDM"},{"code":"11441","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PUNCTURE ASPIRATION CYST BREAST CDM","code_information":[{"code":"Px00045010700","type":"CDM"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF ARM FOREIGN BODY ARM/ELBOW CDM","code_information":[{"code":"Px00045010701","type":"CDM"},{"code":"24201","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA CDM","code_information":[{"code":"Px00045010702","type":"CDM"},{"code":"27635","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR ARM TENDON/MUSCLE CDM","code_information":[{"code":"Px00045010704","type":"CDM"},{"code":"24341","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FX W/O MANIP CDM","code_information":[{"code":"Px00045010705","type":"CDM"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING UNNA BOOT CDM","code_information":[{"code":"Px00045010706","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED WEDGING CAST EXCEPT CLUBFOOT CASTS CDM","code_information":[{"code":"Px00045010708","type":"CDM"},{"code":"29740","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FX W/MANIP CDM","code_information":[{"code":"Px00045010709","type":"CDM"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":1077.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX CDM","code_information":[{"code":"Px00045010712","type":"CDM"},{"code":"33211","type":"HCPCS"}],"standard_charges":[{"gross_charge":23570.0,"discounted_cash":16499.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00045010713","type":"CDM"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH CDM","code_information":[{"code":"Px00045010714","type":"CDM"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED COLLECTION CAPILLARY BLOOD SPECIMEN CDM","code_information":[{"code":"Px00045010716","type":"CDM"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010717","type":"CDM"},{"code":"24535","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CATHJ UMBILICAL VEIN DX/THER NB CDM","code_information":[{"code":"Px00045010718","type":"CDM"},{"code":"36510","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RPLCMT CATH CTR VAD SUBQ PORT/PMP CDM","code_information":[{"code":"Px00045010720","type":"CDM"},{"code":"36578","type":"HCPCS"}],"standard_charges":[{"gross_charge":6368.0,"discounted_cash":4457.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERCUTANEOUS FIXATION HUMERAL CDM","code_information":[{"code":"Px00045010721","type":"CDM"},{"code":"24538","type":"HCPCS"}],"standard_charges":[{"gross_charge":1244.0,"discounted_cash":870.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS EPICOND FRACTURE CDM","code_information":[{"code":"Px00045010722","type":"CDM"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RMVL TUN CVC W/O SUBQ PORT/PMP CDM","code_information":[{"code":"Px00045010723","type":"CDM"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.0,"discounted_cash":865.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ CDM","code_information":[{"code":"Px00045010725","type":"CDM"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":3181.0,"discounted_cash":2226.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS EPICOND FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010726","type":"CDM"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":1077.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL CDM","code_information":[{"code":"Px00045010727","type":"CDM"},{"code":"42310","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM","code_information":[{"code":"Px00045010728","type":"CDM"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2059.0,"discounted_cash":1441.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS CONDYLAR FRACTURE CDM","code_information":[{"code":"Px00045010730","type":"CDM"},{"code":"24576","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERT GASTROSTOMY TUBE PERCUTANEOUS CDM","code_information":[{"code":"Px00045010732","type":"CDM"},{"code":"49440","type":"HCPCS"}],"standard_charges":[{"gross_charge":3722.0,"discounted_cash":2605.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS CDM","code_information":[{"code":"Px00045010733","type":"CDM"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1765.0,"discounted_cash":1235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT HUMERUS CONDYLAR FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010734","type":"CDM"},{"code":"24577","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":1077.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI CDM","code_information":[{"code":"Px00045010735","type":"CDM"},{"code":"57160","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION CHALAZION SINGLE CDM","code_information":[{"code":"Px00045010737","type":"CDM"},{"code":"67800","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":534.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ELBOW DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010738","type":"CDM"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP CDM","code_information":[{"code":"Px00045010739","type":"CDM"},{"code":"96369","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ELBOW DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010741","type":"CDM"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":1534.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR CDM","code_information":[{"code":"Px00045010742","type":"CDM"},{"code":"96370","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION CDM","code_information":[{"code":"Px00045010744","type":"CDM"},{"code":"23515","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANI CDM","code_information":[{"code":"Px00045010745","type":"CDM"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2443.0,"discounted_cash":1710.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE CDM","code_information":[{"code":"Px00045010746","type":"CDM"},{"code":"24516","type":"HCPCS"}],"standard_charges":[{"gross_charge":35882.0,"discounted_cash":25117.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION/CURETTAGE CYST/TUMOR METACARPAL CDM","code_information":[{"code":"Px00045010747","type":"CDM"},{"code":"26200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MANIP CDM","code_information":[{"code":"Px00045010749","type":"CDM"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PRQ SKEL FIXJ FEMORAL FX PROX END NECK CDM","code_information":[{"code":"Px00045010750","type":"CDM"},{"code":"27235","type":"HCPCS"}],"standard_charges":[{"gross_charge":18191.0,"discounted_cash":12733.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT RADIUS FRACTURE CDM","code_information":[{"code":"Px00045010752","type":"CDM"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY CDM","code_information":[{"code":"Px00045010753","type":"CDM"},{"code":"27827","type":"HCPCS"}],"standard_charges":[{"gross_charge":35882.0,"discounted_cash":25117.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA CDM","code_information":[{"code":"Px00045010755","type":"CDM"},{"code":"27828","type":"HCPCS"}],"standard_charges":[{"gross_charge":35882.0,"discounted_cash":25117.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX RADIUS HD FRACTURE CDM","code_information":[{"code":"Px00045010756","type":"CDM"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION CDM","code_information":[{"code":"Px00045010757","type":"CDM"},{"code":"27829","type":"HCPCS"}],"standard_charges":[{"gross_charge":18191.0,"discounted_cash":12733.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION VAGINAL CYST/TUMOR CDM","code_information":[{"code":"Px00045010759","type":"CDM"},{"code":"57135","type":"HCPCS"}],"standard_charges":[{"gross_charge":7776.0,"discounted_cash":5443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ULNAR FRACTURE CDM","code_information":[{"code":"Px00045010760","type":"CDM"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC CDM","code_information":[{"code":"Px00045010761","type":"CDM"},{"code":"96522","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":397.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST CDM","code_information":[{"code":"Px00045010763","type":"CDM"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ULNAR FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010764","type":"CDM"},{"code":"24675","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":1077.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FETAL NONSTRESS TEST CDM","code_information":[{"code":"Px00045010765","type":"CDM"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH CDM","code_information":[{"code":"Px00045010767","type":"CDM"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREARM FOREIGN BODY - WRIST/FOREARM CDM","code_information":[{"code":"Px00045010769","type":"CDM"},{"code":"25248","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU CDM","code_information":[{"code":"Px00045010770","type":"CDM"},{"code":"25260","type":"HCPCS"}],"standard_charges":[{"gross_charge":4129.0,"discounted_cash":2890.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER CDM","code_information":[{"code":"Px00045010771","type":"CDM"},{"code":"31730","type":"HCPCS"}],"standard_charges":[{"gross_charge":4396.0,"discounted_cash":3077.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION CDM","code_information":[{"code":"Px00045010773","type":"CDM"},{"code":"31515","type":"HCPCS"}],"standard_charges":[{"gross_charge":940.0,"discounted_cash":658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FOREARM TENDON/MUSCLE SINGLE EA TENDON CDM","code_information":[{"code":"Px00045010774","type":"CDM"},{"code":"25270","type":"HCPCS"}],"standard_charges":[{"gross_charge":4129.0,"discounted_cash":2890.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE CDM","code_information":[{"code":"Px00045010775","type":"CDM"},{"code":"43753","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":418.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION INTRAUTERINE DEVICE IUD CDM","code_information":[{"code":"Px00045010777","type":"CDM"},{"code":"58300","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF RADIUS W/O MANIPULATION CDM","code_information":[{"code":"Px00045010778","type":"CDM"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE CDM","code_information":[{"code":"Px00045010779","type":"CDM"},{"code":"49460","type":"HCPCS"}],"standard_charges":[{"gross_charge":2270.0,"discounted_cash":1589.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPLACEMENT G-J TUBE PERCUTANEOUS CDM","code_information":[{"code":"Px00045010781","type":"CDM"},{"code":"49452","type":"HCPCS"}],"standard_charges":[{"gross_charge":1765.0,"discounted_cash":1235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF RADIUS W/MANIPULATION CDM","code_information":[{"code":"Px00045010782","type":"CDM"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM","code_information":[{"code":"Px00045010783","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION OF CHEST TUBE CDM","code_information":[{"code":"Px00045010785","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.0,"discounted_cash":488.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT CDM","code_information":[{"code":"Px00045010786","type":"CDM"},{"code":"25520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":731.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM","code_information":[{"code":"Px00045010787","type":"CDM"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1147.0,"discounted_cash":802.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING CDM","code_information":[{"code":"Px00045010789","type":"CDM"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":479.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF ULNA CDM","code_information":[{"code":"Px00045010790","type":"CDM"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING CDM","code_information":[{"code":"Px00045010791","type":"CDM"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.0,"discounted_cash":488.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA CDM","code_information":[{"code":"Px00045010793","type":"CDM"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.0,"discounted_cash":687.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF FRACTURE OF ULNA W/MANIPULATION CDM","code_information":[{"code":"Px00045010794","type":"CDM"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REP TNDN ACHILLES W GRFT CDM","code_information":[{"code":"Px00045010795","type":"CDM"},{"code":"27652","type":"HCPCS"}],"standard_charges":[{"gross_charge":18191.0,"discounted_cash":12733.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REP DISRUPT LIGAMENT ANKL SNGL CDM","code_information":[{"code":"Px00045010797","type":"CDM"},{"code":"27695","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE OF RADIUS AND ULNA W/O MANIP CDM","code_information":[{"code":"Px00045010798","type":"CDM"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED AMPUT METATARSAL W TOE SINGLE CDM","code_information":[{"code":"Px00045010799","type":"CDM"},{"code":"28810","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FRACTURE RADIUS & ULNA W/MANIPULATION CDM","code_information":[{"code":"Px00045010801","type":"CDM"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM CDM","code_information":[{"code":"Px00045010802","type":"CDM"},{"code":"11444","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM","code_information":[{"code":"Px00045010804","type":"CDM"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M LT/4.0CM CDM","code_information":[{"code":"Px00045010805","type":"CDM"},{"code":"11446","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US CDM","code_information":[{"code":"Px00045010807","type":"CDM"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF","code_information":[{"code":"Px00045010808","type":"CDM"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERQ CERVICOTHORACIC INJECT CDM","code_information":[{"code":"Px00045010809","type":"CDM"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PERQ LUMBOSACRAL INJECTION CDM","code_information":[{"code":"Px00045010811","type":"CDM"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT WRIST BONE FRACTURE CDM","code_information":[{"code":"Px00045010812","type":"CDM"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN CDM","code_information":[{"code":"Px00045010813","type":"CDM"},{"code":"24545","type":"HCPCS"}],"standard_charges":[{"gross_charge":35882.0,"discounted_cash":25117.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ LT/3CM CDM","code_information":[{"code":"Px00045010815","type":"CDM"},{"code":"25075","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT WRIST BONE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045010816","type":"CDM"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL CDM","code_information":[{"code":"Px00045010817","type":"CDM"},{"code":"26548","type":"HCPCS"}],"standard_charges":[{"gross_charge":8186.0,"discounted_cash":5730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES CDM","code_information":[{"code":"Px00045010819","type":"CDM"},{"code":"26675","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CARPAL BONE FRACTURE W/O MANIP EACH BONE CDM","code_information":[{"code":"Px00045010820","type":"CDM"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ CDM","code_information":[{"code":"Px00045010821","type":"CDM"},{"code":"27268","type":"HCPCS"}],"standard_charges":[{"gross_charge":4841.0,"discounted_cash":3388.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES CDM","code_information":[{"code":"Px00045010823","type":"CDM"},{"code":"28545","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CARPAL BONE FRACTURE W/MANIP EACH BONE CDM","code_information":[{"code":"Px00045010824","type":"CDM"},{"code":"25635","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":1077.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION SHORT ARM SPLINT DYNAMIC CDM","code_information":[{"code":"Px00045010825","type":"CDM"},{"code":"29126","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION FINGER SPLINT DYNAMIC CDM","code_information":[{"code":"Px00045010827","type":"CDM"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT ULNAR STYLOID FRACTURE CDM","code_information":[{"code":"Px00045010828","type":"CDM"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF CHEST THORAX CDM","code_information":[{"code":"Px00045010829","type":"CDM"},{"code":"29200","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING SHOULDER CDM","code_information":[{"code":"Px00045010831","type":"CDM"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT WRIST DISLOCATION W/MANIPULATION CDM","code_information":[{"code":"Px00045010832","type":"CDM"},{"code":"25660","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF ELBOW OR WRIST CDM","code_information":[{"code":"Px00045010834","type":"CDM"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF HAND OR FINGER CDM","code_information":[{"code":"Px00045010835","type":"CDM"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT DISTAL RADIOULNAR DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010836","type":"CDM"},{"code":"25675","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ADDITION OF WALKER TO CAST CDM","code_information":[{"code":"Px00045010837","type":"CDM"},{"code":"29440","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG CDM","code_information":[{"code":"Px00045010839","type":"CDM"},{"code":"29450","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT TRANS-SCAPHOPERIULNAR FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010840","type":"CDM"},{"code":"25680","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF CDM","code_information":[{"code":"Px00045010841","type":"CDM"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.0,"discounted_cash":865.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT LUNATE DISLOCATION W/MANIPULATION CDM","code_information":[{"code":"Px00045010843","type":"CDM"},{"code":"25690","type":"HCPCS"}],"standard_charges":[{"gross_charge":2443.0,"discounted_cash":1710.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY CDM","code_information":[{"code":"Px00045010844","type":"CDM"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":908.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSERTION PICC W/RS&I 5 YRS OR MORE CDM","code_information":[{"code":"Px00045010846","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3181.0,"discounted_cash":2226.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PIN FINGER FRACTURE EACH CDM","code_information":[{"code":"Px00045010848","type":"CDM"},{"code":"26756","type":"HCPCS"}],"standard_charges":[{"gross_charge":3336.0,"discounted_cash":2335.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX DISTAL PHALANGEAL FRACTURE EACH CDM","code_information":[{"code":"Px00045010849","type":"CDM"},{"code":"26765","type":"HCPCS"}],"standard_charges":[{"gross_charge":3336.0,"discounted_cash":2335.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX FINGER DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010851","type":"CDM"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX FINGER DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045010852","type":"CDM"},{"code":"26775","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED COLLECT BLOOD FROM CATHETER VENOUS NOS CDM","code_information":[{"code":"Px00045010853","type":"CDM"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED XTRNL CANNULA DECLTNG SPX W/O BALO CATH CDM","code_information":[{"code":"Px00045010854","type":"CDM"},{"code":"36860","type":"HCPCS"}],"standard_charges":[{"gross_charge":4297.0,"discounted_cash":3007.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL CDM","code_information":[{"code":"Px00045010855","type":"CDM"},{"code":"38300","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE ABSCESS PAROTID SIMPLE CDM","code_information":[{"code":"Px00045010856","type":"CDM"},{"code":"42300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE ABSCESS PAROTID COMPLICATED CDM","code_information":[{"code":"Px00045010858","type":"CDM"},{"code":"42305","type":"HCPCS"}],"standard_charges":[{"gross_charge":6081.0,"discounted_cash":4256.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF FINGER ABCESS COMP CDM","code_information":[{"code":"Px00045010859","type":"CDM"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1171.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ CDM","code_information":[{"code":"Px00045010860","type":"CDM"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":1765.0,"discounted_cash":1235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER CDM","code_information":[{"code":"Px00045010861","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":2606.0,"discounted_cash":1824.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN CDM","code_information":[{"code":"Px00045010862","type":"CDM"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR CARDIAC WOUND W/O BYPASS CDM","code_information":[{"code":"Px00045010863","type":"CDM"},{"code":"33300","type":"HCPCS"}],"standard_charges":[{"gross_charge":6801.0,"discounted_cash":4760.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM","code_information":[{"code":"Px00045010864","type":"CDM"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP CDM","code_information":[{"code":"Px00045010865","type":"CDM"},{"code":"33320","type":"HCPCS"}],"standard_charges":[{"gross_charge":3010.0,"discounted_cash":2107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US CDM","code_information":[{"code":"Px00045010866","type":"CDM"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.0,"discounted_cash":994.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT CDM","code_information":[{"code":"Px00045010867","type":"CDM"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":323.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION LONG LEG CAST BRACE CDM","code_information":[{"code":"Px00045010869","type":"CDM"},{"code":"29358","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE TENDON SHEATH LESION CDM","code_information":[{"code":"Px00045010870","type":"CDM"},{"code":"26160","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR FINGER/HAND PROFUNDUS TENDON EA TENDON CDM","code_information":[{"code":"Px00045010871","type":"CDM"},{"code":"26370","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EXTENSOR TENDON HAND W/O GRAFT CDM","code_information":[{"code":"Px00045010872","type":"CDM"},{"code":"26410","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":1534.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REM SHOULDER HIP SPICA CDM","code_information":[{"code":"Px00045010875","type":"CDM"},{"code":"29710","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF EXTENSOR TENDON FINGER W/O GRAFT CDM","code_information":[{"code":"Px00045010876","type":"CDM"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":1534.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX CDM","code_information":[{"code":"Px00045010877","type":"CDM"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BX INTRANASAL MUCOSA CDM","code_information":[{"code":"Px00045010878","type":"CDM"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMV FB NOSE BY LAT RHINOTOMY CDM","code_information":[{"code":"Px00045010879","type":"CDM"},{"code":"30320","type":"HCPCS"}],"standard_charges":[{"gross_charge":6081.0,"discounted_cash":4256.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BRONCH DX W WO CELL WASH CDM","code_information":[{"code":"Px00045010880","type":"CDM"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":3986.0,"discounted_cash":2790.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BRONCH DX W ALVEOLAR LAV CDM","code_information":[{"code":"Px00045010881","type":"CDM"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":3986.0,"discounted_cash":2790.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BRONCH W FB REM CDM","code_information":[{"code":"Px00045010882","type":"CDM"},{"code":"31635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3986.0,"discounted_cash":2790.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INS TUN PLEURAL CATH CDM","code_information":[{"code":"Px00045010884","type":"CDM"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":7571.0,"discounted_cash":5299.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR BLD VESSEL DIRECT NECK CDM","code_information":[{"code":"Px00045010885","type":"CDM"},{"code":"35201","type":"HCPCS"}],"standard_charges":[{"gross_charge":14840.0,"discounted_cash":10388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INS TUN CVC WO SQ PORT LT/5YRS CDM","code_information":[{"code":"Px00045010886","type":"CDM"},{"code":"36557","type":"HCPCS"}],"standard_charges":[{"gross_charge":10986.0,"discounted_cash":7690.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING CDM","code_information":[{"code":"Px00045010887","type":"CDM"},{"code":"26432","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":1534.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/GT CDM","code_information":[{"code":"Px00045010888","type":"CDM"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":6368.0,"discounted_cash":4457.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INS PICCCTH WO PRT/PMP LT/5 W US CDM","code_information":[{"code":"Px00045010889","type":"CDM"},{"code":"36572","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.0,"discounted_cash":865.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPLC NON TUN CVC WO PORT PUMP CDM","code_information":[{"code":"Px00045010890","type":"CDM"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":3181.0,"discounted_cash":2226.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPLC TUN CV CATH WO PORT CDM","code_information":[{"code":"Px00045010891","type":"CDM"},{"code":"36581","type":"HCPCS"}],"standard_charges":[{"gross_charge":6368.0,"discounted_cash":4457.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPLC PICC WO PORT PUMP CDM","code_information":[{"code":"Px00045010892","type":"CDM"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":3181.0,"discounted_cash":2226.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LIGATION OR BX TEMPORAL ARTERY CDM","code_information":[{"code":"Px00045010893","type":"CDM"},{"code":"37609","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCSN MOUTH LSN W SMPL REP CDM","code_information":[{"code":"Px00045010894","type":"CDM"},{"code":"40812","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED UGI W DILATION ESOPHAGUS BAL CDM","code_information":[{"code":"Px00045010895","type":"CDM"},{"code":"43249","type":"HCPCS"}],"standard_charges":[{"gross_charge":4343.0,"discounted_cash":3040.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED GASTRC INTUBN ASP DX SNGL SPEC CDM","code_information":[{"code":"Px00045010897","type":"CDM"},{"code":"43754","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":418.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRAFT CDM","code_information":[{"code":"Px00045010898","type":"CDM"},{"code":"26433","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":1534.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR COLLATER LIGMNT METACAROPOPHALANGEAL OR INTERPHAL.JOINT CDM","code_information":[{"code":"Px00045010899","type":"CDM"},{"code":"26540","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":1534.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METACARPAL FRACTURE SINGLE W/O MANIP CDM","code_information":[{"code":"Px00045010900","type":"CDM"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PRESSURE TREATMENT ESOPHAGUS CDM","code_information":[{"code":"Px00045010902","type":"CDM"},{"code":"43460","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.0,"discounted_cash":404.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METACARPAL FRACTURE SINGLE W/MANIPULATION CDM","code_information":[{"code":"Px00045010904","type":"CDM"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRN ABSC PELV TRNSREC CDM","code_information":[{"code":"Px00045010906","type":"CDM"},{"code":"45000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2315.0,"discounted_cash":1620.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SIGMOID DX FLX W WO SPEC COLL CDM","code_information":[{"code":"Px00045010907","type":"CDM"},{"code":"45330","type":"HCPCS"}],"standard_charges":[{"gross_charge":2073.0,"discounted_cash":1451.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT CARPOMETACARPAL DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010909","type":"CDM"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PROCTOPLASTY PROLAPSE MUC MBRM CDM","code_information":[{"code":"Px00045010911","type":"CDM"},{"code":"45505","type":"HCPCS"}],"standard_charges":[{"gross_charge":5493.0,"discounted_cash":3845.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REP PERINEAL APRCH CDM","code_information":[{"code":"Px00045010912","type":"CDM"},{"code":"45541","type":"HCPCS"}],"standard_charges":[{"gross_charge":7066.0,"discounted_cash":4946.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED I&D SUPERF ABSC PERI/ISCHEAL CDM","code_information":[{"code":"Px00045010913","type":"CDM"},{"code":"46045","type":"HCPCS"}],"standard_charges":[{"gross_charge":5493.0,"discounted_cash":3845.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJ SCLEROSING SOL HEMORROIDS CDM","code_information":[{"code":"Px00045010914","type":"CDM"},{"code":"46500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":1243.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TX CARPOMETACARPAL FRACTURE/DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00045010915","type":"CDM"},{"code":"26645","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DESTRUC LSN ANUS SMPL CHEM CDM","code_information":[{"code":"Px00045010917","type":"CDM"},{"code":"46900","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":557.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REM FB FROM PERITNL CAV CDM","code_information":[{"code":"Px00045010918","type":"CDM"},{"code":"49402","type":"HCPCS"}],"standard_charges":[{"gross_charge":9740.0,"discounted_cash":6818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCHG ABSC CYST DRN CATH CDM","code_information":[{"code":"Px00045010919","type":"CDM"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":4789.0,"discounted_cash":3352.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CYSTO TX URETERAL STRICTURE CDM","code_information":[{"code":"Px00045010920","type":"CDM"},{"code":"52344","type":"HCPCS"}],"standard_charges":[{"gross_charge":7993.0,"discounted_cash":5595.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX CARPO/METACARPL DISLO OTHER THAN THMB MANJ EA W/O ANES CDM","code_information":[{"code":"Px00045010921","type":"CDM"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CYSTO DX W URETSCP PYELSCP CDM","code_information":[{"code":"Px00045010923","type":"CDM"},{"code":"52351","type":"HCPCS"}],"standard_charges":[{"gross_charge":7993.0,"discounted_cash":5595.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED I&D PENIS LSN DEEP CDM","code_information":[{"code":"Px00045010924","type":"CDM"},{"code":"54015","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT KNUCKLE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045010926","type":"CDM"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ORCHIOPEXY INGUINAL CDM","code_information":[{"code":"Px00045010927","type":"CDM"},{"code":"54640","type":"HCPCS"}],"standard_charges":[{"gross_charge":9740.0,"discounted_cash":6818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED COLPOSCOPY VULVA CDM","code_information":[{"code":"Px00045010928","type":"CDM"},{"code":"56820","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA CDM","code_information":[{"code":"Px00045010929","type":"CDM"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION HYDRATION EACH ADDITIONAL HOUR CDM","code_information":[{"code":"Px00045010930","type":"CDM"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDEMENT OPEN WOUND 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00045010931","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM CDM","code_information":[{"code":"Px00045010932","type":"CDM"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED COLPOTOMY WITH EXPLORATION CDM","code_information":[{"code":"Px00045010933","type":"CDM"},{"code":"57000","type":"HCPCS"}],"standard_charges":[{"gross_charge":7776.0,"discounted_cash":5443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED COLPOTOMY W DRN PELV ABSCS CDM","code_information":[{"code":"Px00045010934","type":"CDM"},{"code":"57010","type":"HCPCS"}],"standard_charges":[{"gross_charge":7776.0,"discounted_cash":5443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED I&D HEMOTOMA VAG NON-OB CDM","code_information":[{"code":"Px00045010935","type":"CDM"},{"code":"57023","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CAUTERIZATION CHEMICAL CERVIX CDM","code_information":[{"code":"Px00045010936","type":"CDM"},{"code":"58999","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OB ED-FETAL CONTRACT STRESS NS CDM","code_information":[{"code":"Px00045010938","type":"CDM"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OB ED-EXT CEPHAL VERS BREECH N CDM","code_information":[{"code":"Px00045010939","type":"CDM"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":7776.0,"discounted_cash":5443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INDUCED ABORT DILATION CURETGE CDM","code_information":[{"code":"Px00045010940","type":"CDM"},{"code":"59840","type":"HCPCS"}],"standard_charges":[{"gross_charge":6044.0,"discounted_cash":4230.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA CDM","code_information":[{"code":"Px00045010942","type":"CDM"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX PHALANGEAL SHAFT FRACTURE FINGER OR THUMB W/MANIP EA CDM","code_information":[{"code":"Px00045010943","type":"CDM"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OB ED-REM CERCLAGE SUT ANES NS CDM","code_information":[{"code":"Px00045010944","type":"CDM"},{"code":"59871","type":"HCPCS"}],"standard_charges":[{"gross_charge":6044.0,"discounted_cash":4230.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJ INTERLAMINR CRV-THOR W IMG CDM","code_information":[{"code":"Px00045010945","type":"CDM"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM","code_information":[{"code":"Px00045010946","type":"CDM"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJ EPI LUMB/SACRAL W IMAGING CDM","code_information":[{"code":"Px00045010947","type":"CDM"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJ INF INTRLAM CRV THOR WO XR CDM","code_information":[{"code":"Px00045010948","type":"CDM"},{"code":"62324","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE CDM","code_information":[{"code":"Px00045010949","type":"CDM"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":557.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ CDM","code_information":[{"code":"Px00045010950","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ANALYZE SP INFUS PMP W REPROG CDM","code_information":[{"code":"Px00045010951","type":"CDM"},{"code":"62368","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":413.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJ ANES NRV PUDENAL CDM","code_information":[{"code":"Px00045010952","type":"CDM"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION AA&/STRD SCIATIC NRV CONT NFS CATH IMG CDM","code_information":[{"code":"Px00045010953","type":"CDM"},{"code":"64446","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX PHALANGEAL SHAFT FX FINGER/THUMB W/O MANIP CDM","code_information":[{"code":"Px00045010954","type":"CDM"},{"code":"26735","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NRV BLOCK INJ CELIAC PLEXUS CDM","code_information":[{"code":"Px00045010957","type":"CDM"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":1275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJ EYE ANT CHAMBER W MEDS CDM","code_information":[{"code":"Px00045010958","type":"CDM"},{"code":"66030","type":"HCPCS"}],"standard_charges":[{"gross_charge":6236.0,"discounted_cash":4365.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RECON EYELID CDM","code_information":[{"code":"Px00045010959","type":"CDM"},{"code":"67950","type":"HCPCS"}],"standard_charges":[{"gross_charge":6105.0,"discounted_cash":4273.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXPLR TEAR DUCTS W WO IRRIG CDM","code_information":[{"code":"Px00045010960","type":"CDM"},{"code":"68840","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":534.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED US GUID VASC ACCESS CDM","code_information":[{"code":"Px00045010962","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":446.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX ARTICULAR FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045010963","type":"CDM"},{"code":"26740","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED VENOUS PRESSURE DETERMINATION CDM","code_information":[{"code":"Px00045010964","type":"CDM"},{"code":"93770","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SUBQ IV INFUSION ADDL SITE CDM","code_information":[{"code":"Px00045010965","type":"CDM"},{"code":"96371","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ANOGENTL COLPO PED TRAUMA CDM","code_information":[{"code":"Px00045010966","type":"CDM"},{"code":"99170","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX ARTICULAR FRACTURE W/MANIP CDM","code_information":[{"code":"Px00045010974","type":"CDM"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":1077.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TX ARTICULARE FRACTURE CDM","code_information":[{"code":"Px00045010985","type":"CDM"},{"code":"26746","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX DISTAL PHALANGEAL FX FINGER/THUMB W/O MANIP EA -TUFT CDM","code_information":[{"code":"Px00045010986","type":"CDM"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACT PART WO PHOSP NOTIF CDM","code_information":[{"code":"Px00045010989","type":"CDM"},{"code":"TR450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2415.0,"discounted_cash":1690.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX DISTAL PHALANG FX FINGER/THUMB W/MANIP TUFT FX CDM","code_information":[{"code":"Px00045010996","type":"CDM"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP CDM","code_information":[{"code":"Px00045011000","type":"CDM"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IV HYDRATION INITIAL HR CDM","code_information":[{"code":"Px00045011001","type":"CDM"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION THERAPY PROPHYLAXIS ADDL SEQUENTIAL TO 1 HR CDM","code_information":[{"code":"Px00045011002","type":"CDM"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION TX/PROPHYLAXIS/DX EA ADDNL HOUR CDM","code_information":[{"code":"Px00045011003","type":"CDM"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM","code_information":[{"code":"Px00045011004","type":"CDM"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IV INFUSION TX/PROPHYLAXIS/DX CONCURRENT DRUG CDM","code_information":[{"code":"Px00045011005","type":"CDM"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PULSE OXIMETRY MULT MEASUREMENTS ONCE/DAY CDM","code_information":[{"code":"Px00045011006","type":"CDM"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE CDM","code_information":[{"code":"Px00045011009","type":"CDM"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH EA SEQL SBST/DRUG FAC CDM","code_information":[{"code":"Px00045011010","type":"CDM"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM","code_information":[{"code":"Px00045011011","type":"CDM"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH EACH NEW DRUG CDM","code_information":[{"code":"Px00045011012","type":"CDM"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM","code_information":[{"code":"Px00045011013","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL CDM","code_information":[{"code":"Px00045011014","type":"CDM"},{"code":"96373","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.0,"discounted_cash":308.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS CDM","code_information":[{"code":"Px00045011015","type":"CDM"},{"code":"96379","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED WOUND CLOSURE BY ADHESIVE CDM","code_information":[{"code":"Px00045011016","type":"CDM"},{"code":"G0168","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT CDM","code_information":[{"code":"Px00045011088","type":"CDM"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX PROX TIBFIB JT DISLC REQ ANES CDM","code_information":[{"code":"Px00045011089","type":"CDM"},{"code":"27831","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN CDM","code_information":[{"code":"Px00045011090","type":"CDM"},{"code":"99466","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":445.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN CDM","code_information":[{"code":"Px00045011091","type":"CDM"},{"code":"99467","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION PILONIDAL CYST/SINUS SIMPLE CDM","code_information":[{"code":"Px00045011092","type":"CDM"},{"code":"11770","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM CDM","code_information":[{"code":"Px00045011093","type":"CDM"},{"code":"11621","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC CDM","code_information":[{"code":"Px00045011094","type":"CDM"},{"code":"43755","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE CDM","code_information":[{"code":"Px00045011095","type":"CDM"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP CDM","code_information":[{"code":"Px00045011096","type":"CDM"},{"code":"36575","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.0,"discounted_cash":865.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TELEHEALTH FACILITY FEE CDM","code_information":[{"code":"Px00045011097","type":"CDM"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TEMPORARY CLOSURE EYELID BY SUTURE CDM","code_information":[{"code":"Px00045011111","type":"CDM"},{"code":"67875","type":"HCPCS"}],"standard_charges":[{"gross_charge":1866.0,"discounted_cash":1306.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT OF ANKLE FX DIS FIBULA W/MANIP CDM","code_information":[{"code":"Px00045013002","type":"CDM"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045013005","type":"CDM"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF ANKLE FRACTURE BIMALL W/MANIP CDM","code_information":[{"code":"Px00045013009","type":"CDM"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF ANKLE FRACTURE TRIMAL W/O MANIP CDM","code_information":[{"code":"Px00045013011","type":"CDM"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF ANKLE FRACTURE TRIMALL W/MANIP CDM","code_information":[{"code":"Px00045013015","type":"CDM"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":511.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT LOWER LEG FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045013018","type":"CDM"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT LOWER LEG FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013020","type":"CDM"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":2501.0,"discounted_cash":1750.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREATMENT OF ANKLE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045013021","type":"CDM"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT ANKLE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045013025","type":"CDM"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":1758.0,"discounted_cash":1230.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREAT ANKLE DISLOCATION CDM","code_information":[{"code":"Px00045013027","type":"CDM"},{"code":"27846","type":"HCPCS"}],"standard_charges":[{"gross_charge":18191.0,"discounted_cash":12733.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOOT FOREIGN BODY CDM","code_information":[{"code":"Px00045013029","type":"CDM"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":1055.0,"discounted_cash":738.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOOT FOREIGN BODY DEEP CDM","code_information":[{"code":"Px00045013032","type":"CDM"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":2167.0,"discounted_cash":1516.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF FOOT FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00045013036","type":"CDM"},{"code":"28193","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF FOOT TENDON CDM","code_information":[{"code":"Px00045013039","type":"CDM"},{"code":"28200","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF FOOT TENDON EXTENSOR TENDON CDM","code_information":[{"code":"Px00045013040","type":"CDM"},{"code":"28208","type":"HCPCS"}],"standard_charges":[{"gross_charge":2818.0,"discounted_cash":1972.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RELEASE OF BIG TOE CDM","code_information":[{"code":"Px00045013043","type":"CDM"},{"code":"28240","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF HEEL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045013045","type":"CDM"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF HEEL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013048","type":"CDM"},{"code":"28405","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF TALUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00045013051","type":"CDM"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT OF ANKLE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013054","type":"CDM"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT MIDFOOT FRACTURE EACH W/O MANIPULATION CDM","code_information":[{"code":"Px00045013056","type":"CDM"},{"code":"28450","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT MIDFOOT FRACTURE EACH W/MANIPULATION CDM","code_information":[{"code":"Px00045013059","type":"CDM"},{"code":"28455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":1077.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT METATARSAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00045013063","type":"CDM"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT METATARSAL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013065","type":"CDM"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT BIG TOE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00045013069","type":"CDM"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN TREAT BIG TOE FRACTURE CDM","code_information":[{"code":"Px00045013074","type":"CDM"},{"code":"28505","type":"HCPCS"}],"standard_charges":[{"gross_charge":6363.0,"discounted_cash":4454.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ CDM","code_information":[{"code":"Px00045013075","type":"CDM"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ CDM","code_information":[{"code":"Px00045013076","type":"CDM"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT SESAMOID BONE FRACTURE CDM","code_information":[{"code":"Px00045013077","type":"CDM"},{"code":"28530","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TARSAL DISLOCATION CDM","code_information":[{"code":"Px00045013078","type":"CDM"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION CDM","code_information":[{"code":"Px00045013082","type":"CDM"},{"code":"28570","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00045013083","type":"CDM"},{"code":"28575","type":"HCPCS"}],"standard_charges":[{"gross_charge":1412.0,"discounted_cash":988.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045013084","type":"CDM"},{"code":"28600","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX METATARSOPHLNGL JT DISLC W/O ANES CDM","code_information":[{"code":"Px00045013087","type":"CDM"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLTX METATARSOPHLNGL JT DISLC REQ ANES CDM","code_information":[{"code":"Px00045013090","type":"CDM"},{"code":"28635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TREAT TOE DISLOCATION CDM","code_information":[{"code":"Px00045013091","type":"CDM"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT TOE DISLOCATION W/ANETH CDM","code_information":[{"code":"Px00045013092","type":"CDM"},{"code":"28665","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF BODY CAST CDM","code_information":[{"code":"Px00045013094","type":"CDM"},{"code":"29035","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF SHOULDER CAST CDM","code_information":[{"code":"Px00045013095","type":"CDM"},{"code":"29055","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LONG ARM CAST APPLICATION CDM","code_information":[{"code":"Px00045013096","type":"CDM"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SHORT ARM CAST APPLICATION CDM","code_information":[{"code":"Px00045013099","type":"CDM"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLY HAND/WRIST CAST CDM","code_information":[{"code":"Px00045013103","type":"CDM"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLY FINGER CAST CDM","code_information":[{"code":"Px00045013105","type":"CDM"},{"code":"29086","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LONG ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00045013106","type":"CDM"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SHORT ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00045013110","type":"CDM"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF FINGER SPLINT STATIC CDM","code_information":[{"code":"Px00045013112","type":"CDM"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF HIP CAST CDM","code_information":[{"code":"Px00045013119","type":"CDM"},{"code":"29305","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF HIP CASTS CDM","code_information":[{"code":"Px00045013120","type":"CDM"},{"code":"29325","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION OF LONG LEG CAST CDM","code_information":[{"code":"Px00045013121","type":"CDM"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CYLINDER CAST APPLICATION CDM","code_information":[{"code":"Px00045013122","type":"CDM"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SHORT LEG CAST APPLICATION CDM","code_information":[{"code":"Px00045013123","type":"CDM"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLY SHORT WALKING LEG CAST CDM","code_information":[{"code":"Px00045013124","type":"CDM"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED APPLICATION LONG LEG SPLINT CDM","code_information":[{"code":"Px00045013127","type":"CDM"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SHORT LEG SPLINT APPLICATION CDM","code_information":[{"code":"Px00045013130","type":"CDM"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF KNEE CDM","code_information":[{"code":"Px00045013135","type":"CDM"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF ANKLE AND/OR FT CDM","code_information":[{"code":"Px00045013137","type":"CDM"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":217.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED STRAPPING OF TOES CDM","code_information":[{"code":"Px00045013139","type":"CDM"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOV BIVAL GAUN BOOT/BODY CAST CDM","code_information":[{"code":"Px00045013145","type":"CDM"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE OR BIVALVE CAST-FULL ARM OR LEG CDM","code_information":[{"code":"Px00045013147","type":"CDM"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR OF BODY CAST CDM","code_information":[{"code":"Px00045013150","type":"CDM"},{"code":"29720","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED WINDOWING OF CAST CDM","code_information":[{"code":"Px00045013151","type":"CDM"},{"code":"29730","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLOSED TX OF PORC TIBIOFIBULAR JOINT DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00045013166","type":"CDM"},{"code":"27830","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY FROM EYE CORNEAL W/ SLIT LAMP CDM","code_information":[{"code":"Px00045013170","type":"CDM"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF MOUTH LESION COMPL CDM","code_information":[{"code":"Px00045013172","type":"CDM"},{"code":"40801","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAIN OUTER EAR CANAL LESION CDM","code_information":[{"code":"Px00045013173","type":"CDM"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL OF NOSEBLEED POSTERIOR CDM","code_information":[{"code":"Px00045013183","type":"CDM"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ CDM","code_information":[{"code":"Px00045013185","type":"CDM"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NASAL ENDOSCOPY DX CDM","code_information":[{"code":"Px00045013187","type":"CDM"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":312.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED NASAL/SINUS ENDOSCOPY SURG W/ HEMORRHAGE CONTROL CDM","code_information":[{"code":"Px00045013188","type":"CDM"},{"code":"31238","type":"HCPCS"}],"standard_charges":[{"gross_charge":3986.0,"discounted_cash":2790.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED SINUS ENDO W/BALLOON DILATION CDM","code_information":[{"code":"Px00045013189","type":"CDM"},{"code":"31295","type":"HCPCS"}],"standard_charges":[{"gross_charge":15429.0,"discounted_cash":10800.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CHANGE OF WINDPIPE AIRWAY CDM","code_information":[{"code":"Px00045013191","type":"CDM"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY INDIRECT CDM","code_information":[{"code":"Px00045013192","type":"CDM"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY LARYNX INDIRECT CDM","code_information":[{"code":"Px00045013193","type":"CDM"},{"code":"31511","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY NEWBORN CDM","code_information":[{"code":"Px00045013194","type":"CDM"},{"code":"31520","type":"HCPCS"}],"standard_charges":[{"gross_charge":940.0,"discounted_cash":658.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DX LARYNGOSCOPY EXCL NEWBORN CDM","code_information":[{"code":"Px00045013195","type":"CDM"},{"code":"31525","type":"HCPCS"}],"standard_charges":[{"gross_charge":3611.0,"discounted_cash":2527.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LARYNGOSCOPY W/FB REMOVAL CDM","code_information":[{"code":"Px00045013196","type":"CDM"},{"code":"31530","type":"HCPCS"}],"standard_charges":[{"gross_charge":3611.0,"discounted_cash":2527.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC LARYNGOSCOPY CDM","code_information":[{"code":"Px00045013197","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED LARYNGOSCOPY WITH BIOPSY CDM","code_information":[{"code":"Px00045013198","type":"CDM"},{"code":"31576","type":"HCPCS"}],"standard_charges":[{"gross_charge":3157.0,"discounted_cash":2209.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE FOREIGN BODY LARYNX FLEXIBLE FIBEROPTIC CDM","code_information":[{"code":"Px00045013199","type":"CDM"},{"code":"31577","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.0,"discounted_cash":522.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL OF LARYNX LESION CDM","code_information":[{"code":"Px00045013200","type":"CDM"},{"code":"31578","type":"HCPCS"}],"standard_charges":[{"gross_charge":5146.0,"discounted_cash":3602.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TRACHEOSTOMY CDM","code_information":[{"code":"Px00045013201","type":"CDM"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"discounted_cash":1071.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CRICOTHYROIDOTOMY CDM","code_information":[{"code":"Px00045013202","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"discounted_cash":1071.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED VISUALIZATION OF WINDPIPE CDM","code_information":[{"code":"Px00045013203","type":"CDM"},{"code":"31615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":797.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EXPLORATION/BIOPSY OF CHEST CDM","code_information":[{"code":"Px00045013206","type":"CDM"},{"code":"32100","type":"HCPCS"}],"standard_charges":[{"gross_charge":7967.0,"discounted_cash":5576.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPEN CHEST HEART MASSAGE CDM","code_information":[{"code":"Px00045013207","type":"CDM"},{"code":"32160","type":"HCPCS"}],"standard_charges":[{"gross_charge":8624.0,"discounted_cash":6036.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR AV FISTULA EXTREMITIES CDM","code_information":[{"code":"Px00045013209","type":"CDM"},{"code":"35190","type":"HCPCS"}],"standard_charges":[{"gross_charge":14840.0,"discounted_cash":10388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR BLOOD VESSEL LESION UPPER EXTREMITY CDM","code_information":[{"code":"Px00045013210","type":"CDM"},{"code":"35206","type":"HCPCS"}],"standard_charges":[{"gross_charge":8601.0,"discounted_cash":6020.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR BLOOD VESSEL LESION HAND/FINGER CDM","code_information":[{"code":"Px00045013211","type":"CDM"},{"code":"35207","type":"HCPCS"}],"standard_charges":[{"gross_charge":8601.0,"discounted_cash":6020.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR LIP FULL THICKNESS VERMILION ONLY CDM","code_information":[{"code":"Px00045013214","type":"CDM"},{"code":"40650","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR LIP FULL THICKNESS UP TO HALF VERTICAL HEIGHT CDM","code_information":[{"code":"Px00045013215","type":"CDM"},{"code":"40652","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RPR LIP FULL THKNS GT/ONE-HALF VERT HEIGHT/COMPLE CDM","code_information":[{"code":"Px00045013216","type":"CDM"},{"code":"40654","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF MOUTH LESION SIMPLE CDM","code_information":[{"code":"Px00045013217","type":"CDM"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY MOUTH SIMPLE CDM","code_information":[{"code":"Px00045013218","type":"CDM"},{"code":"40804","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY MOUTH COMPLEX CDM","code_information":[{"code":"Px00045013219","type":"CDM"},{"code":"40805","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR MOUTH LACERATION LT/2.5CM CDM","code_information":[{"code":"Px00045013220","type":"CDM"},{"code":"40830","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":277.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR MOUTH LACERATION GT/2.5CM CDM","code_information":[{"code":"Px00045013221","type":"CDM"},{"code":"40831","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF MOUTH LESION LINGUAL CDM","code_information":[{"code":"Px00045013222","type":"CDM"},{"code":"41000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.0,"discounted_cash":1505.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INCISION & DRAINAGE OF MOUTH LESION SUBLINGUAL SUPERFICIAL CDM","code_information":[{"code":"Px00045013223","type":"CDM"},{"code":"41005","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR TONGUE LAC LT/2.6CM FLOOR OF MOUTH AND/OR ANTERIOR TWO-T CDM","code_information":[{"code":"Px00045013224","type":"CDM"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR TONGUE LACERATION LT/2.6CM POSTERIOR ONE-THIRD OF TONGUE CDM","code_information":[{"code":"Px00045013225","type":"CDM"},{"code":"41251","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED RPR LAC TONGUE FLOOR MOUTH GT/2.6 CM/CPLX CDM","code_information":[{"code":"Px00045013226","type":"CDM"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"discounted_cash":1071.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVAL FOREIGN BODY GUM CDM","code_information":[{"code":"Px00045013227","type":"CDM"},{"code":"41805","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.0,"discounted_cash":2076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE MOUTH ROOF LESION CDM","code_information":[{"code":"Px00045013229","type":"CDM"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":277.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREATMENT MOUTH ROOF LESION CDM","code_information":[{"code":"Px00045013230","type":"CDM"},{"code":"42160","type":"HCPCS"}],"standard_charges":[{"gross_charge":6081.0,"discounted_cash":4256.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REPAIR LACERATION OF PALATE UP TO 2 CM CDM","code_information":[{"code":"Px00045013231","type":"CDM"},{"code":"42180","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF TONSIL ABSCESS CDM","code_information":[{"code":"Px00045013232","type":"CDM"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":277.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DRAINAGE OF THROAT ABSCESS CDM","code_information":[{"code":"Px00045013233","type":"CDM"},{"code":"42720","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.0,"discounted_cash":1505.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE PHARYNX FOREIGN BODY CDM","code_information":[{"code":"Px00045013234","type":"CDM"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CONTROL THROAT BLEEDING SIMPLE CDM","code_information":[{"code":"Px00045013235","type":"CDM"},{"code":"42960","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":95.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOSCOPY FLEXIBLE BRUSH CDM","code_information":[{"code":"Px00045013237","type":"CDM"},{"code":"43200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1430.0,"discounted_cash":1001.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ESOPHAGOSCOPY FLEX REMOVE FB CDM","code_information":[{"code":"Px00045013238","type":"CDM"},{"code":"43215","type":"HCPCS"}],"standard_charges":[{"gross_charge":4113.0,"discounted_cash":2879.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED EGD US FINE NEEDLE BX/ASPIR CDM","code_information":[{"code":"Px00045013240","type":"CDM"},{"code":"43242","type":"HCPCS"}],"standard_charges":[{"gross_charge":4343.0,"discounted_cash":3040.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE CDM","code_information":[{"code":"Px00045013243","type":"CDM"},{"code":"43753","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":418.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED I/D FINGER ABSC-SIM-FA CDM","code_information":[{"code":"Px00045014005","type":"CDM"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLSD TX TOE FX W/O MANIP CDM","code_information":[{"code":"Px00045014022","type":"CDM"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA CDM","code_information":[{"code":"Px00045014033","type":"CDM"},{"code":"57452","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH CDM","code_information":[{"code":"Px00045014035","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":347.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00045014038","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH CDM","code_information":[{"code":"Px00045014040","type":"CDM"},{"code":"92975","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":731.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ABD PARACENTESIS W/O IMAG GUID CDM","code_information":[{"code":"Px00045014046","type":"CDM"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":1316.0,"discounted_cash":921.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED ABD PARACENTESIS W/IMAG GUIDANCE CDM","code_information":[{"code":"Px00045014047","type":"CDM"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":800.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FAC PERITONEAL LAVAGE CDM","code_information":[{"code":"Px00045014048","type":"CDM"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.0,"discounted_cash":791.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00045014050","type":"CDM"},{"code":"46601","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":202.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TREAT FOOT DISLOCATION W/ ANESTHESIA CDM","code_information":[{"code":"Px00045014051","type":"CDM"},{"code":"28605","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FUSION OF HAND BONES CDM","code_information":[{"code":"Px00045014052","type":"CDM"},{"code":"25820","type":"HCPCS"}],"standard_charges":[{"gross_charge":14139.0,"discounted_cash":9897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED CLEAR OUTER EAR CANAL CDM","code_information":[{"code":"Px00045014053","type":"CDM"},{"code":"69205","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":2244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED MANIPULATE WRIST W/ANESTHES CDM","code_information":[{"code":"Px00045014054","type":"CDM"},{"code":"25259","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":2146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED OPN TX ORBIT FX W/O IMPLANT CDM","code_information":[{"code":"Px00045014055","type":"CDM"},{"code":"21406","type":"HCPCS"}],"standard_charges":[{"gross_charge":14684.0,"discounted_cash":10278.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED REMOVE EAR CANAL LESION(S) CDM","code_information":[{"code":"Px00045014056","type":"CDM"},{"code":"69145","type":"HCPCS"}],"standard_charges":[{"gross_charge":5522.0,"discounted_cash":3865.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST CDM","code_information":[{"code":"Px00045044404","type":"CDM"},{"code":"31645","type":"HCPCS"}],"standard_charges":[{"gross_charge":3986.0,"discounted_cash":2790.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION CDM","code_information":[{"code":"Px00045050511","type":"CDM"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT CDM","code_information":[{"code":"Px00046010002","type":"CDM"},{"code":"94070","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":543.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG","code_information":[{"code":"Px00046010011","type":"CDM"},{"code":"94617","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CO/MEMBANE DIFFUSE CAPACITY","code_information":[{"code":"Px00046010012","type":"CDM"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":316.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOR OTH","code_information":[{"code":"Px00046010024","type":"CDM"},{"code":"94727","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":466.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ","code_information":[{"code":"Px00046010026","type":"CDM"},{"code":"94200","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PULMONARY STRESS TESTING - SIX MINUTE WALK CDM","code_information":[{"code":"Px00046010048","type":"CDM"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":284.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RESPIRATORY FLOW VOLUME LOOP","code_information":[{"code":"Px00046010053","type":"CDM"},{"code":"94375","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ","code_information":[{"code":"Px00046010055","type":"CDM"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SPIROMETRY PRE POST BRONCHODILATOR CDM","code_information":[{"code":"Px00046010063","type":"CDM"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX","code_information":[{"code":"Px00046010080","type":"CDM"},{"code":"94690","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST CDM","code_information":[{"code":"Px00046010089","type":"CDM"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP","code_information":[{"code":"Px00046010091","type":"CDM"},{"code":"94680","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BEDSIDE SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ CDM","code_information":[{"code":"Px00046010092","type":"CDM"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":174.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL","code_information":[{"code":"Px00048010001","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":532.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP","code_information":[{"code":"Px00048010057","type":"CDM"},{"code":"93307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1071.0,"discounted_cash":749.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD","code_information":[{"code":"Px00048010059","type":"CDM"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY","code_information":[{"code":"Px00048010074","type":"CDM"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":408.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST","code_information":[{"code":"Px00048010075","type":"CDM"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.0,"discounted_cash":763.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ECHO TTE 2D W/WO CONTRAST DOP COLOR","code_information":[{"code":"Px00048010077","type":"CDM"},{"code":"C8929","type":"HCPCS"}],"standard_charges":[{"gross_charge":1405.0,"discounted_cash":983.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY","code_information":[{"code":"Px00048210003","type":"CDM"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":326.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ECHO TTE 2D W DOPPLER COMPLETE","code_information":[{"code":"Px00048310003","type":"CDM"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ECHO W/WO CONTRAST COMPLETE","code_information":[{"code":"Px00048310019","type":"CDM"},{"code":"C8923","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.0,"discounted_cash":752.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ECHO W/WO CONTRAST F/U LIMITED","code_information":[{"code":"Px00048310020","type":"CDM"},{"code":"C8924","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.0,"discounted_cash":752.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ECHO W/WO CONTRAST STRESS TEST","code_information":[{"code":"Px00048310024","type":"CDM"},{"code":"C8928","type":"HCPCS"}],"standard_charges":[{"gross_charge":1405.0,"discounted_cash":983.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ACNE SURGERY  CDM","code_information":[{"code":"Px00051010402","type":"CDM"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1  CDM","code_information":[{"code":"Px00051010403","type":"CDM"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SHAVING SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM  CDM","code_information":[{"code":"Px00051010408","type":"CDM"},{"code":"11302","type":"HCPCS"}],"standard_charges":[{"gross_charge":812.0,"discounted_cash":568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/OR LESS CDM","code_information":[{"code":"Px00051010410","type":"CDM"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS CDM","code_information":[{"code":"Px00051010417","type":"CDM"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM CDM","code_information":[{"code":"Px00051010418","type":"CDM"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM CDM","code_information":[{"code":"Px00051010419","type":"CDM"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS CDM","code_information":[{"code":"Px00051010424","type":"CDM"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM  CDM","code_information":[{"code":"Px00051010426","type":"CDM"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DESTRUCTION BENIGN LESIONS UP TO 14  CDM","code_information":[{"code":"Px00051010446","type":"CDM"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC  CDM","code_information":[{"code":"Px00051010467","type":"CDM"},{"code":"11011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1387.0,"discounted_cash":970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI IMAGE JAW JOINT TMJ","code_information":[{"code":"Px00061010002","type":"CDM"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":1945.0,"discounted_cash":1361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI ORBIT/FACE/NECK W CONTRAST","code_information":[{"code":"Px00061010005","type":"CDM"},{"code":"70542","type":"HCPCS"}],"standard_charges":[{"gross_charge":3542.0,"discounted_cash":2479.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI ORBIT/FACE/NECK WO & W CONTRAST","code_information":[{"code":"Px00061010007","type":"CDM"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":4327.0,"discounted_cash":3028.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD WO CONTRAST","code_information":[{"code":"Px00061010009","type":"CDM"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":2796.0,"discounted_cash":1957.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD W CONTRAST","code_information":[{"code":"Px00061010010","type":"CDM"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":3532.0,"discounted_cash":2472.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA HEAD WO & W CONTRAST","code_information":[{"code":"Px00061010012","type":"CDM"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":4668.0,"discounted_cash":3267.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA NECK WO CONTRAST","code_information":[{"code":"Px00061010013","type":"CDM"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":2995.0,"discounted_cash":2096.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA NECK W CONTRAST","code_information":[{"code":"Px00061010014","type":"CDM"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":3727.0,"discounted_cash":2608.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA NECK WO & W CONTRAST","code_information":[{"code":"Px00061010015","type":"CDM"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":4701.0,"discounted_cash":3290.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI CHEST WO CONTRAST","code_information":[{"code":"Px00061010019","type":"CDM"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":2467.0,"discounted_cash":1726.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI CHEST WO CONTRAST","code_information":[{"code":"Px00061010022","type":"CDM"},{"code":"71551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3326.0,"discounted_cash":2328.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI CHEST WO & W CONTRAST","code_information":[{"code":"Px00061010025","type":"CDM"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3589.0,"discounted_cash":2512.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS WO CONTRAST","code_information":[{"code":"Px00061010029","type":"CDM"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":2705.0,"discounted_cash":1893.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS W CONTRAST","code_information":[{"code":"Px00061010038","type":"CDM"},{"code":"72196","type":"HCPCS"}],"standard_charges":[{"gross_charge":3593.0,"discounted_cash":2515.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI PELVIS WO & W CONTRAST","code_information":[{"code":"Px00061010044","type":"CDM"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":5478.0,"discounted_cash":3834.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010053","type":"CDM"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":4618.0,"discounted_cash":3232.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY NO JOINT WO CONTRAST","code_information":[{"code":"Px00061010054","type":"CDM"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":2699.0,"discounted_cash":1889.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT W CONTRAST","code_information":[{"code":"Px00061010057","type":"CDM"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":3265.0,"discounted_cash":2285.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY NO JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010059","type":"CDM"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":4049.0,"discounted_cash":2834.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY JOINT WO CONTRAST","code_information":[{"code":"Px00061010063","type":"CDM"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":3004.0,"discounted_cash":2102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY NO JOINT WO CONTRAST","code_information":[{"code":"Px00061010065","type":"CDM"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":2886.0,"discounted_cash":2020.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010068","type":"CDM"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":5229.0,"discounted_cash":3660.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY JOINT WO CONTRAST","code_information":[{"code":"Px00061010075","type":"CDM"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":2985.0,"discounted_cash":2089.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY JOINT W CONTRAST","code_information":[{"code":"Px00061010077","type":"CDM"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":3915.0,"discounted_cash":2740.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST","code_information":[{"code":"Px00061010079","type":"CDM"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":4760.0,"discounted_cash":3332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI MRCP ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010082","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.0,"discounted_cash":2934.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN WO CONTRAST","code_information":[{"code":"Px00061010083","type":"CDM"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.0,"discounted_cash":2934.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN W CONTRAST","code_information":[{"code":"Px00061010085","type":"CDM"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":4510.0,"discounted_cash":3157.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI ABDOMEN WO & W CONTRAST","code_information":[{"code":"Px00061010087","type":"CDM"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":5609.0,"discounted_cash":3926.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC FOR MORPH","code_information":[{"code":"Px00061010090","type":"CDM"},{"code":"75557","type":"HCPCS"}],"standard_charges":[{"gross_charge":1488.0,"discounted_cash":1041.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC W/STRESS IMG","code_information":[{"code":"Px00061010091","type":"CDM"},{"code":"75559","type":"HCPCS"}],"standard_charges":[{"gross_charge":1488.0,"discounted_cash":1041.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC FOR MORPH W/WO DYE","code_information":[{"code":"Px00061010092","type":"CDM"},{"code":"75561","type":"HCPCS"}],"standard_charges":[{"gross_charge":2273.0,"discounted_cash":1591.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI CARDIAC W/STRESS IMG & DYE","code_information":[{"code":"Px00061010093","type":"CDM"},{"code":"75563","type":"HCPCS"}],"standard_charges":[{"gross_charge":2273.0,"discounted_cash":1591.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI SPECTROSCOPY","code_information":[{"code":"Px00061010095","type":"CDM"},{"code":"76390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1932.0,"discounted_cash":1352.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI BONE MARROW BLOOD SUPPLY","code_information":[{"code":"Px00061010100","type":"CDM"},{"code":"77084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1969.0,"discounted_cash":1378.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010114","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2978.0,"discounted_cash":2084.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010115","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2717.0,"discounted_cash":1901.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"Px00061010116","type":"CDM"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3240.0,"discounted_cash":2268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA SPINAL CANAL W/WO CONTRAST","code_information":[{"code":"Px00061010120","type":"CDM"},{"code":"72159","type":"HCPCS"}],"standard_charges":[{"gross_charge":3056.0,"discounted_cash":2139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA W/O CONTRAST SPINAL CANAL","code_information":[{"code":"Px00061010121","type":"CDM"},{"code":"72159","type":"HCPCS"}],"standard_charges":[{"gross_charge":2533.0,"discounted_cash":1773.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA W/O AND W/CONT SPINAL CANAL","code_information":[{"code":"Px00061010122","type":"CDM"},{"code":"72159","type":"HCPCS"}],"standard_charges":[{"gross_charge":3056.0,"discounted_cash":2139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA W/CONTRAST UPPER EXTREMITY","code_information":[{"code":"Px00061010123","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2978.0,"discounted_cash":2084.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA W/O CONTRAST UPPER EXTREMITY","code_information":[{"code":"Px00061010124","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2717.0,"discounted_cash":1901.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA W/O AND W/CONT UPPER EXTREMITY","code_information":[{"code":"Px00061010125","type":"CDM"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":3240.0,"discounted_cash":2268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI UPPER EXTREMITY W/DYE","code_information":[{"code":"Px00061010137","type":"CDM"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":3808.0,"discounted_cash":2665.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI ORBIT/FACE/NECK W/O DYE","code_information":[{"code":"Px00061010142","type":"CDM"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":2261.0,"discounted_cash":1582.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA CHEST W/O & W/CONTRAST MATERIAL","code_information":[{"code":"Px00061010143","type":"CDM"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3326.0,"discounted_cash":2328.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA CHEST W/O & W/CONTRAST MATERIAL","code_information":[{"code":"Px00061010144","type":"CDM"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3326.0,"discounted_cash":2328.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MR ANGIO PELVIS W/O DYE","code_information":[{"code":"Px00061010148","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":1851.0,"discounted_cash":1295.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI JOINT UPR EXTREM W/O DYE LIMITED","code_information":[{"code":"Px00061010184","type":"CDM"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":3004.0,"discounted_cash":2102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI ANGIO ABDOM W & W/O DYE","code_information":[{"code":"Px00061010237","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":3205.0,"discounted_cash":2243.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI ANGIO ABDOM W/DYE","code_information":[{"code":"Px00061010238","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":2736.0,"discounted_cash":1915.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI ANGIO ABDOM W/O DYE","code_information":[{"code":"Px00061010239","type":"CDM"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":2394.0,"discounted_cash":1675.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN STEM W/O DYE","code_information":[{"code":"Px00061110001","type":"CDM"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3046.0,"discounted_cash":2132.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/DYE","code_information":[{"code":"Px00061110007","type":"CDM"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3248.0,"discounted_cash":2273.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI BRAIN W/O & W/DYE","code_information":[{"code":"Px00061110015","type":"CDM"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":5205.0,"discounted_cash":3643.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/O DYE","code_information":[{"code":"Px00061210001","type":"CDM"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":2888.0,"discounted_cash":2021.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/DYE","code_information":[{"code":"Px00061210003","type":"CDM"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":2113.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/O DYE","code_information":[{"code":"Px00061210005","type":"CDM"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":3027.0,"discounted_cash":2118.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/DYE","code_information":[{"code":"Px00061210007","type":"CDM"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":3377.0,"discounted_cash":2363.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/O DYE","code_information":[{"code":"Px00061210009","type":"CDM"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":3544.0,"discounted_cash":2480.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/O DYE LIMITED","code_information":[{"code":"Px00061210010","type":"CDM"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":3145.0,"discounted_cash":2201.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/DYE","code_information":[{"code":"Px00061210011","type":"CDM"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":4321.0,"discounted_cash":3024.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI CERVICAL SPINE W/O & W/DYE","code_information":[{"code":"Px00061210013","type":"CDM"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":4706.0,"discounted_cash":3294.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI THORACIC SPINE W/O & W/DYE","code_information":[{"code":"Px00061210015","type":"CDM"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":4661.0,"discounted_cash":3262.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRI LUMBAR SPINE W/O & W/DYE","code_information":[{"code":"Px00061210017","type":"CDM"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":5497.0,"discounted_cash":3847.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MRA PELVIS WO & W CONTRAST","code_information":[{"code":"Px00061210028","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":2486.0,"discounted_cash":1740.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MR ANGIO PELVIS W/DYE","code_information":[{"code":"Px00061810001","type":"CDM"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":2324.0,"discounted_cash":1626.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR RX COVID-19 VACCINE SINGLE DOSE (NOVAVAX) PF ADJ IM 5 MCG/0.5 ML","code_information":[{"code":"Px00063600166","type":"CDM"},{"code":"91304","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC PR RX COV19 VAC SINGLE DOS (PFIZER) PF 6M TO 4Y TRIS-SUC IM 3 MCG/0.3 ML","code_information":[{"code":"Px00063600167","type":"CDM"},{"code":"91318","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":91.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC PR RX COV19 VAC SGL DOSE (PFIZER) PF 5Y TO 11Y TRIS-SUC IM 10 MCG/0.3 ML","code_information":[{"code":"Px00063600168","type":"CDM"},{"code":"91319","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC PR RX COVID-19 VACCINE SINGLE DOSE (PFIZER) PF TRIS-SUC IM 30 MCG/0.3 ML","code_information":[{"code":"Px00063600169","type":"CDM"},{"code":"91320","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":183.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC PR RX COVID-19 VAC SINGLE DOSE (MODERNA) PF 6M TO 11Y IM 25 M","code_information":[{"code":"Px00063600170","type":"CDM"},{"code":"91321","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC PR RX COVID-19 VACCINE SINGLE DOSE (MODERNA) PF IM 50 MCG/0.5 ML","code_information":[{"code":"Px00063600171","type":"CDM"},{"code":"91322","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC PR RX RHO D IMMUNE GLOBULIN INJ 300 MCG (1500 IU)","code_information":[{"code":"Px00063610194","type":"CDM"},{"code":"J2790","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION PARTIAL WITH CRITICAL CARE G0390 CDM","code_information":[{"code":"Px00068210001","type":"CDM"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"gross_charge":2566.0,"discounted_cash":1796.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION PARTIAL WO CRITICAL CARE CDM","code_information":[{"code":"Px00068210002","type":"CDM"}],"standard_charges":[{"gross_charge":2777.0,"discounted_cash":1943.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ED TRAUMA ACTIVATION FULL WITH CRITICAL CARE G0390 CDM","code_information":[{"code":"Px00068310001","type":"CDM"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"gross_charge":2879.0,"discounted_cash":2015.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 INITIAL 15","code_information":[{"code":"Px00071010131","type":"CDM"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 INITIAL 15","code_information":[{"code":"Px00071010132","type":"CDM"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 INITIAL 15","code_information":[{"code":"Px00071010133","type":"CDM"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 INITIAL 15","code_information":[{"code":"Px00071010134","type":"CDM"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 INITIAL 15","code_information":[{"code":"Px00071010135","type":"CDM"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":398.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 1 PER MIN","code_information":[{"code":"Px00071010231","type":"CDM"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 2 PER MIN","code_information":[{"code":"Px00071010232","type":"CDM"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 3 PER MIN","code_information":[{"code":"Px00071010233","type":"CDM"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 4 PER MIN","code_information":[{"code":"Px00071010234","type":"CDM"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PACU ACUITY LVL 5 PER MIN","code_information":[{"code":"Px00071010358","type":"CDM"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ECG 12 LEAD TRACING ONLY","code_information":[{"code":"Px00073010002","type":"CDM"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RHYTHM ECG TRACING ONLY","code_information":[{"code":"Px00073010003","type":"CDM"},{"code":"93041","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ANORECTAL MANOMETRY","code_information":[{"code":"Px00075010001","type":"CDM"},{"code":"91122","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.0,"discounted_cash":623.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BREATH HYDROGEN TEST","code_information":[{"code":"Px00075010003","type":"CDM"},{"code":"91065","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY SCREENING","code_information":[{"code":"Px00075010014","type":"CDM"}],"standard_charges":[{"gross_charge":1701.0,"discounted_cash":1190.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ BIOPSY","code_information":[{"code":"Px00075010015","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ BLEEDING CONT","code_information":[{"code":"Px00075010016","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLOREC SCREEN HIGH RISK","code_information":[{"code":"Px00075010020","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLOREC SCREEN LOW RISK","code_information":[{"code":"Px00075010021","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD BIOPSY SINGLE/MULTIPLE","code_information":[{"code":"Px00075010024","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD CONTROL BLEEDING ANY","code_information":[{"code":"Px00075010025","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENTEROSCOPY","code_information":[{"code":"Px00075010032","type":"CDM"}],"standard_charges":[{"gross_charge":2088.0,"discounted_cash":1461.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ERCP","code_information":[{"code":"Px00075010033","type":"CDM"}],"standard_charges":[{"gross_charge":4804.0,"discounted_cash":3362.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGEAL MANOMETRY","code_information":[{"code":"Px00075010037","type":"CDM"},{"code":"91010","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.0,"discounted_cash":596.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FLEXIBLE SIGMOIDOSCOPY W/ BIOPOSY","code_information":[{"code":"Px00075010046","type":"CDM"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1397.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC UNLISTED GASTEROENTOLOGY PROCEDURE","code_information":[{"code":"Px00075010049","type":"CDM"},{"code":"91299","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GASTROESOPHAGEAL REFLUX TEST","code_information":[{"code":"Px00075010050","type":"CDM"},{"code":"91034","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":373.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC G-ESOPH REFLUX TEST","code_information":[{"code":"Px00075010054","type":"CDM"},{"code":"91035","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":373.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GI TRACT CAPSULE ENDOSCOPY","code_information":[{"code":"Px00075010056","type":"CDM"},{"code":"91110","type":"HCPCS"}],"standard_charges":[{"gross_charge":2091.0,"discounted_cash":1463.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IRC TREATMENT","code_information":[{"code":"Px00075010058","type":"CDM"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":784.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ BLEEDING CONTROL","code_information":[{"code":"Px00075010074","type":"CDM"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1397.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC UPPR GI SCOPE W/SUBMUC INJ","code_information":[{"code":"Px00075010084","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD W/ ABLATION","code_information":[{"code":"Px00075010085","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD VARICES LIGATION","code_information":[{"code":"Px00075010086","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD GUIDE WIRE INSERTION","code_information":[{"code":"Px00075010087","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD PLACE GASTROSTOMY TUBE","code_information":[{"code":"Px00075010088","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD W/ REMOVAL OF FB","code_information":[{"code":"Px00075010089","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENTERO JEJUNUM SNARE","code_information":[{"code":"Px00075010090","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY POLP/HOT BX","code_information":[{"code":"Px00075010098","type":"CDM"}],"standard_charges":[{"gross_charge":4221.0,"discounted_cash":2954.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY POLYP SNARE","code_information":[{"code":"Px00075010099","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY THRU STOMA","code_information":[{"code":"Px00075010100","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ SUBMUC INJ","code_information":[{"code":"Px00075010101","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/ ABLATION","code_information":[{"code":"Px00075010102","type":"CDM"}],"standard_charges":[{"gross_charge":4221.0,"discounted_cash":2954.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DILAT ANAL SPHNCTER A/ANESTH","code_information":[{"code":"Px00075010104","type":"CDM"}],"standard_charges":[{"gross_charge":3557.0,"discounted_cash":2489.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DILAT RECTAL STRX W/ANESTH","code_information":[{"code":"Px00075010105","type":"CDM"}],"standard_charges":[{"gross_charge":3557.0,"discounted_cash":2489.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD DIAGNOSTIC BRUSH WASH","code_information":[{"code":"Px00075010106","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD DILATE STRICTURE","code_information":[{"code":"Px00075010107","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESOPH EGD DILATION/LESS THAN 30 MM","code_information":[{"code":"Px00075010108","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD INJ SCLEROS VARICES","code_information":[{"code":"Px00075010109","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ERCP WITH BIOPSY","code_information":[{"code":"Px00075010110","type":"CDM"}],"standard_charges":[{"gross_charge":4804.0,"discounted_cash":3362.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HEMORRHOID INT BANDING","code_information":[{"code":"Px00075010111","type":"CDM"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":784.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY DX PROCURE","code_information":[{"code":"Px00075010113","type":"CDM"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":963.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ ABLATION","code_information":[{"code":"Px00075010114","type":"CDM"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1397.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ BALLOON DILATION","code_information":[{"code":"Px00075010115","type":"CDM"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1397.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ DIR SUBMUC INJ","code_information":[{"code":"Px00075010116","type":"CDM"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1397.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ REMOVAL FB","code_information":[{"code":"Px00075010117","type":"CDM"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1397.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ SNARE REMOVAL","code_information":[{"code":"Px00075010118","type":"CDM"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1397.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ STENT PL","code_information":[{"code":"Px00075010119","type":"CDM"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1397.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC UNLISTED PROC INTESTINE","code_information":[{"code":"Px00075010120","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENTEROSCOPY W/ BIOPSYJEJUNUM","code_information":[{"code":"Px00075010121","type":"CDM"}],"standard_charges":[{"gross_charge":2088.0,"discounted_cash":1461.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ERCP W/ REMOVAL CALCULUS","code_information":[{"code":"Px00075010123","type":"CDM"}],"standard_charges":[{"gross_charge":4804.0,"discounted_cash":3362.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ERCP W/ SPHINCTER/PAPILLO","code_information":[{"code":"Px00075010124","type":"CDM"}],"standard_charges":[{"gross_charge":4804.0,"discounted_cash":3362.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGUS SCOPE W/SUBMUCOUS INJ","code_information":[{"code":"Px00075010132","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY FLEX BIOPSY","code_information":[{"code":"Px00075010133","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESOPH ENDO DILATION BALLOON/LESS THAN 30 MM","code_information":[{"code":"Px00075010134","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD TUBE/CATH INSERTION","code_information":[{"code":"Px00075010137","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD CAUTERY TUMOR POLYP","code_information":[{"code":"Px00075010141","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD REMOVE LESION SNARE","code_information":[{"code":"Px00075010142","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENDO CHOLANGIOPANCREATOGRAPH W/ LITHOTRIPSY","code_information":[{"code":"Px00075010149","type":"CDM"}],"standard_charges":[{"gross_charge":4804.0,"discounted_cash":3362.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DILATE ESOPHAGUS, UNGUIDED","code_information":[{"code":"Px00075010154","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DILATE ESOPHAGUS, OVER GUIDE WIRE","code_information":[{"code":"Px00075010155","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PRESSURE TREATMENT ESOPHAGUS","code_information":[{"code":"Px00075010157","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BIOPSY OF BOWEL","code_information":[{"code":"Px00075010158","type":"CDM"}],"standard_charges":[{"gross_charge":2577.0,"discounted_cash":1803.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, W/ FB REMOVAL","code_information":[{"code":"Px00075010161","type":"CDM"}],"standard_charges":[{"gross_charge":2088.0,"discounted_cash":1461.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, W/ HOT BIOPSY","code_information":[{"code":"Px00075010163","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, W/ BLEED CONTROL","code_information":[{"code":"Px00075010164","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, W/ TUBE PLACEMENT","code_information":[{"code":"Px00075010165","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, CONVERT J-TUBE","code_information":[{"code":"Px00075010166","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, ILEOSCOPY","code_information":[{"code":"Px00075010167","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY, ILEOSCOPY W/ BIOPSY","code_information":[{"code":"Px00075010168","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY THROUGH STOMA","code_information":[{"code":"Px00075010170","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY FOR FOREIGN BODY","code_information":[{"code":"Px00075010171","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY FOR BLEEDING","code_information":[{"code":"Px00075010172","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY & POLYPECTOMY","code_information":[{"code":"Px00075010173","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/SNARE","code_information":[{"code":"Px00075010174","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY & POLYPECTOMY","code_information":[{"code":"Px00075010178","type":"CDM"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1397.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY & DECOMPRESS","code_information":[{"code":"Px00075010182","type":"CDM"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1397.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COLONOSCOPY W/FB REMOVAL","code_information":[{"code":"Px00075010185","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NDO RECTAL ULTRASOUND PROCEDURE","code_information":[{"code":"Px00075010189","type":"CDM"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESPHGSC W/OPTICAL ENDOMICROSCOPY","code_information":[{"code":"Px00075010203","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD OPTICAL ENDOMICROSCOPY","code_information":[{"code":"Px00075010204","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER","code_information":[{"code":"Px00075010206","type":"CDM"},{"code":"52287","type":"HCPCS"}],"standard_charges":[{"gross_charge":2641.0,"discounted_cash":1848.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP","code_information":[{"code":"Px00075010207","type":"CDM"},{"code":"91112","type":"HCPCS"}],"standard_charges":[{"gross_charge":706.0,"discounted_cash":494.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DILAT RECTAL STRX W/ANESTH","code_information":[{"code":"Px00075010213","type":"CDM"}],"standard_charges":[{"gross_charge":3557.0,"discounted_cash":2489.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHEMODENERVATION ANAL MUSC","code_information":[{"code":"Px00075010214","type":"CDM"},{"code":"46505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3622.0,"discounted_cash":2535.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSCOPY FLEX DX BRUSH","code_information":[{"code":"Px00075010225","type":"CDM"}],"standard_charges":[{"gross_charge":2142.0,"discounted_cash":1499.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESOPHAGOSC DILATE BALLOON 30","code_information":[{"code":"Px00075010230","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD BALLOON DIL ESOPH30 MM/>","code_information":[{"code":"Px00075010232","type":"CDM"}],"standard_charges":[{"gross_charge":4898.0,"discounted_cash":3428.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD ENDOSCOPIC STENT PLACE","code_information":[{"code":"Px00075010235","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC EGD LESION ABLATION","code_information":[{"code":"Px00075010236","type":"CDM"}],"standard_charges":[{"gross_charge":3429.0,"discounted_cash":2400.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ERCP DUCT STENT PLACEMENT","code_information":[{"code":"Px00075010237","type":"CDM"}],"standard_charges":[{"gross_charge":2615.0,"discounted_cash":1830.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ERCP REMOVE FORGN BODY DUCT","code_information":[{"code":"Px00075010238","type":"CDM"}],"standard_charges":[{"gross_charge":2615.0,"discounted_cash":1830.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ERCP STENT EXCHANGE W/DILATE","code_information":[{"code":"Px00075010239","type":"CDM"}],"standard_charges":[{"gross_charge":2615.0,"discounted_cash":1830.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ERCP EA DUCT/AMPULLA DILATE","code_information":[{"code":"Px00075010240","type":"CDM"}],"standard_charges":[{"gross_charge":4804.0,"discounted_cash":3362.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 6","code_information":[{"code":"Px00075010272","type":"CDM"}],"standard_charges":[{"gross_charge":6308.0,"discounted_cash":4415.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPIC PANCREATOSCOPY","code_information":[{"code":"Px00075010306","type":"CDM"}],"standard_charges":[{"gross_charge":4617.0,"discounted_cash":3231.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SMALL BOWEL ENDOSCOPY","code_information":[{"code":"Px00075010307","type":"CDM"}],"standard_charges":[{"gross_charge":4221.0,"discounted_cash":2954.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC SIGMOIDOSCOPY W/ULTRASOUND","code_information":[{"code":"Px00075010308","type":"CDM"}],"standard_charges":[{"gross_charge":3323.0,"discounted_cash":2326.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC CHEMODENERVATION ANAL MUSC","code_information":[{"code":"Px00075010309","type":"CDM"}],"standard_charges":[{"gross_charge":3557.0,"discounted_cash":2489.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 1","code_information":[{"code":"Px00075010315","type":"CDM"}],"standard_charges":[{"gross_charge":2358.0,"discounted_cash":1650.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 2","code_information":[{"code":"Px00075010316","type":"CDM"}],"standard_charges":[{"gross_charge":2946.0,"discounted_cash":2062.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 3","code_information":[{"code":"Px00075010317","type":"CDM"}],"standard_charges":[{"gross_charge":4106.0,"discounted_cash":2874.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 4","code_information":[{"code":"Px00075010318","type":"CDM"}],"standard_charges":[{"gross_charge":5335.0,"discounted_cash":3734.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC ENDOSCOPY/GASTROINTESTINAL PROCEDURE LEVEL 5","code_information":[{"code":"Px00075010319","type":"CDM"}],"standard_charges":[{"gross_charge":5870.0,"discounted_cash":4109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00076110006","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 5","code_information":[{"code":"Px00076110021","type":"CDM"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":447.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IRRIGATION OF BLADDER","code_information":[{"code":"Px00076110037","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":331.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 2","code_information":[{"code":"Px00076110039","type":"CDM"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":168.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00076110040","type":"CDM"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ESTAB PT VISIT - LEVEL 4","code_information":[{"code":"Px00076110041","type":"CDM"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":277.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IRRIGATION IMPLANTED VAD","code_information":[{"code":"Px00076110307","type":"CDM"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/OR LESS","code_information":[{"code":"Px00076110466","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":520.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM","code_information":[{"code":"Px00076110467","type":"CDM"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":288.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS","code_information":[{"code":"Px00076110468","type":"CDM"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":296.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC HOSPITAL OBSERVATION PER HR CDM","code_information":[{"code":"Px00076210001","type":"CDM"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DIRECT REFERRAL TO OBSERVATION CARE CDM","code_information":[{"code":"Px00076210010","type":"CDM"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC COVID 19 IMMUNIZATION SINGLE DOSE ADMIN CDM","code_information":[{"code":"Px00077100046","type":"CDM"},{"code":"90480","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"}]},{"description":"HC IMMUNIZATION ADMIN CDM","code_information":[{"code":"Px00077110001","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC IMMUNIZATION ADMIN EACH ADD CDM","code_information":[{"code":"Px00077110002","type":"CDM"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ADMIN INFLUENZA VIRUS VAC CDM","code_information":[{"code":"Px00077110003","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ADMIN PNEUMOCOCCAL VACCINE CDM","code_information":[{"code":"Px00077110004","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC ADMIN HEPATITIS B VACCINE CDM","code_information":[{"code":"Px00077110005","type":"CDM"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":76.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FAMILY PSYTX W/O PATIENT 45 MIN","code_information":[{"code":"Px00091610007","type":"CDM"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC FAMILY PSYTX W/O PATIENT 90 MIN","code_information":[{"code":"Px00091610009","type":"CDM"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":317.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY","code_information":[{"code":"Px00092110002","type":"CDM"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":1146.0,"discounted_cash":802.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI","code_information":[{"code":"Px00092110009","type":"CDM"},{"code":"93924","type":"HCPCS"}],"standard_charges":[{"gross_charge":1006.0,"discounted_cash":704.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY","code_information":[{"code":"Px00092110010","type":"CDM"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":2461.0,"discounted_cash":1722.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY","code_information":[{"code":"Px00092110011","type":"CDM"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":740.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY","code_information":[{"code":"Px00092110012","type":"CDM"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1888.0,"discounted_cash":1321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY","code_information":[{"code":"Px00092110013","type":"CDM"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.0,"discounted_cash":847.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY","code_information":[{"code":"Px00092110015","type":"CDM"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":1337.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY","code_information":[{"code":"Px00092110016","type":"CDM"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1313.0,"discounted_cash":919.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM","code_information":[{"code":"Px00092110017","type":"CDM"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":1999.0,"discounted_cash":1399.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT","code_information":[{"code":"Px00092110018","type":"CDM"},{"code":"93976","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":621.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE","code_information":[{"code":"Px00092110019","type":"CDM"},{"code":"93978","type":"HCPCS"}],"standard_charges":[{"gross_charge":1394.0,"discounted_cash":975.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD","code_information":[{"code":"Px00092110020","type":"CDM"},{"code":"93979","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":468.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL","code_information":[{"code":"Px00092110028","type":"CDM"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":349.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC BEHAV CHNG SMOKING > 10 MIN","code_information":[{"code":"Px00094010004","type":"CDM"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INSERT STRAIGHT CATH BLADDER","code_information":[{"code":"Px00094010050","type":"CDM"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE","code_information":[{"code":"Px00094010051","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJ SQ OR IM CDM","code_information":[{"code":"Px00094010205","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJ IV PUSH INITIAL DRUG CDM","code_information":[{"code":"Px00094010207","type":"CDM"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC INJ IV PUSH SEQUENTIAL NEW DRUG CDM","code_information":[{"code":"Px00094010208","type":"CDM"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":149.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC CDM","code_information":[{"code":"Px00094010209","type":"CDM"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM","code_information":[{"code":"Px00094210001","type":"CDM"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC MED NUTRITION INDIV SUBSEQ EA 15 MIN CDM","code_information":[{"code":"Px00094210013","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR CDM","code_information":[{"code":"Px00094800001","type":"CDM"},{"code":"94625","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR CDM","code_information":[{"code":"Px00094800002","type":"CDM"},{"code":"94626","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01937 ANES PERQ IMG NJX DRG/ASPIR PX SPI/SP CRV/THRC CDM","code_information":[{"code":"Px00096300013","type":"CDM"},{"code":"01937","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01938 ANES PERQ IMG NJX DRG/ASPIR PX SPI/SP LMBR/SAC CDM","code_information":[{"code":"Px00096300014","type":"CDM"},{"code":"01938","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01939 ANES PERQ IMG DSTRJ PX NULYT AGT SPI/SP CRV/THRC CDM","code_information":[{"code":"Px00096300015","type":"CDM"},{"code":"01939","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01940 ANES PERQ IMG DSTRJ PX NULYT AGT SPI/SP LMBR/SAC CDM","code_information":[{"code":"Px00096300016","type":"CDM"},{"code":"01940","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01941 ANES PERQ IMG NEUROMD/NTRVRT PX SPI/SP CRV/THRC CDM","code_information":[{"code":"Px00096300017","type":"CDM"},{"code":"01941","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01942 ANES PERQ IMG NEUROMD/NTRVRT PX SPI/SP LMBR/SAC CDM","code_information":[{"code":"Px00096300018","type":"CDM"},{"code":"01942","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00142 ANESTH LENS SURGERY","code_information":[{"code":"Px00096310009","type":"CDM"},{"code":"00142","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00454 ANESTH COLLAR BONE BIOPSY","code_information":[{"code":"Px00096310010","type":"CDM"},{"code":"00454","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01432 ANESTH KNEE VESSEL SURG","code_information":[{"code":"Px00096310013","type":"CDM"},{"code":"01432","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00300 ANESTH HEAD/NECK/PTRUNK","code_information":[{"code":"Px00096310023","type":"CDM"},{"code":"00300","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00320 ANES ESOPH THYRD LARYNX TRACH & LYMPH NECK 1YR","code_information":[{"code":"Px00096310024","type":"CDM"},{"code":"00320","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00322 ANESTH BIOPSY OF THYROID","code_information":[{"code":"Px00096310025","type":"CDM"},{"code":"00322","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00350 ANESTH NECK VESSEL SURGERY","code_information":[{"code":"Px00096310026","type":"CDM"},{"code":"00350","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00352 ANESTH NECK VESSEL SURGERY","code_information":[{"code":"Px00096310027","type":"CDM"},{"code":"00352","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00400 ANESTH SKIN EXT/PER/ATRUNK","code_information":[{"code":"Px00096310028","type":"CDM"},{"code":"00400","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00402 ANESTH SURGERY OF BREAST","code_information":[{"code":"Px00096310029","type":"CDM"},{"code":"00402","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00404 ANESTH SURGERY OF BREAST RADICAL","code_information":[{"code":"Px00096310030","type":"CDM"},{"code":"00404","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00406 ANESTH SURGERY OF BREAST RAD OR MOD W/ INT MAM","code_information":[{"code":"Px00096310031","type":"CDM"},{"code":"00406","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00410 ANESTH CORRECT HEART RHYTHM","code_information":[{"code":"Px00096310032","type":"CDM"},{"code":"00410","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00450 ANESTH SURGERY OF SHOULDER","code_information":[{"code":"Px00096310033","type":"CDM"},{"code":"00450","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00470 ANESTH REMOVAL OF RIB","code_information":[{"code":"Px00096310035","type":"CDM"},{"code":"00470","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00472 ANESTH CHEST WALL REPAIR","code_information":[{"code":"Px00096310036","type":"CDM"},{"code":"00472","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00474 ANESTH SURGERY OF RIB(S)","code_information":[{"code":"Px00096310037","type":"CDM"},{"code":"00474","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00500 ANESTH ESOPHAGEAL SURGERY","code_information":[{"code":"Px00096310038","type":"CDM"},{"code":"00500","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00520 ANESTH CHEST PROCEDURE","code_information":[{"code":"Px00096310039","type":"CDM"},{"code":"00520","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00522 ANESTH CHEST LINING BIOPSY","code_information":[{"code":"Px00096310040","type":"CDM"},{"code":"00522","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00524 ANESTH CHEST DRAINAGE","code_information":[{"code":"Px00096310041","type":"CDM"},{"code":"00524","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00528 ANESTH MEDIASCPY & DX THORSCPY","code_information":[{"code":"Px00096310042","type":"CDM"},{"code":"00528","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00529 ANESTH MEDSCPY&THORSCPY 1 LUNG W/VENT","code_information":[{"code":"Px00096310043","type":"CDM"},{"code":"00529","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00530 ANESTH PACEMAKER INSERTION","code_information":[{"code":"Px00096310044","type":"CDM"},{"code":"00530","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00532 ANESTH VASCULAR ACCESS","code_information":[{"code":"Px00096310045","type":"CDM"},{"code":"00532","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00534 ANESTH CARDIOVERTER/DEFIB","code_information":[{"code":"Px00096310046","type":"CDM"},{"code":"00534","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00540 ANESTH CHEST SURGERY","code_information":[{"code":"Px00096310047","type":"CDM"},{"code":"00540","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00541 ANESTH ONE LUNG VENTILATION","code_information":[{"code":"Px00096310048","type":"CDM"},{"code":"00541","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00542 ANESTH RELEASE OF LUNG","code_information":[{"code":"Px00096310049","type":"CDM"},{"code":"00542","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00546 ANESTH LUNG CHEST WALL SURG","code_information":[{"code":"Px00096310050","type":"CDM"},{"code":"00546","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00548 ANESTH TRACHEA BRONCHI SURG","code_information":[{"code":"Px00096310051","type":"CDM"},{"code":"00548","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00630 ANESTH LUMBAR REGION NOS","code_information":[{"code":"Px00096310052","type":"CDM"},{"code":"00630","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00635 ANESTH LUMBAR PUNCTURE","code_information":[{"code":"Px00096310053","type":"CDM"},{"code":"00635","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00640 ANESTH SPINE MANIPULATION","code_information":[{"code":"Px00096310054","type":"CDM"},{"code":"00640","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00700 ANESTH ABDOMINAL WALL SURG","code_information":[{"code":"Px00096310055","type":"CDM"},{"code":"00700","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00702 ANESTH FOR LIVER BIOPSY","code_information":[{"code":"Px00096310056","type":"CDM"},{"code":"00702","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00730 ANESTH ABDOMINAL WALL SURG","code_information":[{"code":"Px00096310057","type":"CDM"},{"code":"00730","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00750 ANESTH REPAIR OF UPPER HERNIA","code_information":[{"code":"Px00096310059","type":"CDM"},{"code":"00750","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00752 ANESTH REPAIR OF HERNIA VENTRIL &INCISION","code_information":[{"code":"Px00096310060","type":"CDM"},{"code":"00752","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00754 ANESTH REPAIR UPPER ABD OMPHALOCELE","code_information":[{"code":"Px00096310061","type":"CDM"},{"code":"00754","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00756 ANESTH REPAIR OF HERNIA UPPER ABD TRANSABD OF DIAPH","code_information":[{"code":"Px00096310062","type":"CDM"},{"code":"00756","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00770 ANESTH BLOOD VESSEL REPAIR","code_information":[{"code":"Px00096310063","type":"CDM"},{"code":"00770","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00790 ANESTH SURG UPPER ABDOMEN","code_information":[{"code":"Px00096310064","type":"CDM"},{"code":"00790","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00792 ANESTH HEMORR/EXCISE LIVER","code_information":[{"code":"Px00096310065","type":"CDM"},{"code":"00792","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00794 ANESTH PANCREAS REMOVAL","code_information":[{"code":"Px00096310066","type":"CDM"},{"code":"00794","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00797 ANESTH SURGERY FOR OBESITY","code_information":[{"code":"Px00096310067","type":"CDM"},{"code":"00797","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00800 ANESTH ABDOMINAL WALL SURG","code_information":[{"code":"Px00096310068","type":"CDM"},{"code":"00800","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00802 ANESTH FAT LAYER REMOVAL","code_information":[{"code":"Px00096310069","type":"CDM"},{"code":"00802","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00820 ANESTH ABDOMINAL WALL SURG","code_information":[{"code":"Px00096310071","type":"CDM"},{"code":"00820","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00830 ANESTH REPAIR OF INGUINAL HERNIA","code_information":[{"code":"Px00096310072","type":"CDM"},{"code":"00830","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00832 ANESTH REPAIR OF HERNIA VENTRI&INCISION","code_information":[{"code":"Px00096310073","type":"CDM"},{"code":"00832","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 31551 LARYNGO W/GRFT W/O STNT YOUNGER THAN 1 YEAR","code_information":[{"code":"Px00096310074","type":"CDM"},{"code":"00834","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00840 ANESTH SURG LOWER ABDOMEN","code_information":[{"code":"Px00096310075","type":"CDM"},{"code":"00840","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00844 ANESTH PELVIS SURGERY","code_information":[{"code":"Px00096310076","type":"CDM"},{"code":"00844","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00846 ANESTH HYSTERECTOMY","code_information":[{"code":"Px00096310077","type":"CDM"},{"code":"00846","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00848 ANESTH PELVIC ORGAN SURG","code_information":[{"code":"Px00096310078","type":"CDM"},{"code":"00848","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00851 ANESTH TUBAL LIGATION","code_information":[{"code":"Px00096310079","type":"CDM"},{"code":"00851","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00860 ANESTH SURGERY OF ABDOMEN","code_information":[{"code":"Px00096310080","type":"CDM"},{"code":"00860","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00862 ANESTH KIDNEY/URETER SURG","code_information":[{"code":"Px00096310081","type":"CDM"},{"code":"00862","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00864 ANESTH REMOVAL OF BLADDER","code_information":[{"code":"Px00096310082","type":"CDM"},{"code":"00864","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00865 ANESTH REMOVAL OF PROSTATE","code_information":[{"code":"Px00096310083","type":"CDM"},{"code":"00865","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00866 ANESTH REMOVAL OF ADRENAL","code_information":[{"code":"Px00096310084","type":"CDM"},{"code":"00866","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00870 ANESTH BLADDER STONE SURG","code_information":[{"code":"Px00096310085","type":"CDM"},{"code":"00870","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00872 ANESTH KIDNEY STONE DESTRUCT WITH BATH","code_information":[{"code":"Px00096310086","type":"CDM"},{"code":"00872","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00873 ANESTH KIDNEY STONE DESTRUCT-LITHOTRIPSY","code_information":[{"code":"Px00096310087","type":"CDM"},{"code":"00873","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00880 ANESTH ABDOMEN VESSEL SURG","code_information":[{"code":"Px00096310088","type":"CDM"},{"code":"00880","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00902 ANESTH ANORECTAL SURGERY","code_information":[{"code":"Px00096310089","type":"CDM"},{"code":"00902","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00904 ANESTH PERINEAL SURGERY","code_information":[{"code":"Px00096310090","type":"CDM"},{"code":"00904","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00906 ANESTH REMOVAL OF VULVA","code_information":[{"code":"Px00096310091","type":"CDM"},{"code":"00906","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00908 ANESTH REMOVAL OF PROSTATE","code_information":[{"code":"Px00096310092","type":"CDM"},{"code":"00908","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00910 ANESTH BLADDER SURGERY","code_information":[{"code":"Px00096310093","type":"CDM"},{"code":"00910","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00912 ANESTH BLADDER TUMOR SURG","code_information":[{"code":"Px00096310094","type":"CDM"},{"code":"00912","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00914 ANESTH REMOVAL OF PROSTATE","code_information":[{"code":"Px00096310095","type":"CDM"},{"code":"00914","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00916 ANESTH BLEEDING CONTROL","code_information":[{"code":"Px00096310096","type":"CDM"},{"code":"00916","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00918 ANESTH STONE REMOVAL","code_information":[{"code":"Px00096310097","type":"CDM"},{"code":"00918","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00920 ANESTH GENITALIA SURGERY","code_information":[{"code":"Px00096310098","type":"CDM"},{"code":"00920","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00924 ANESTH TESTIS EXPLORATION","code_information":[{"code":"Px00096310099","type":"CDM"},{"code":"00924","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00926 ANESTH REMOVAL OF TESTIS INGUINAL","code_information":[{"code":"Px00096310100","type":"CDM"},{"code":"00926","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00928 ANESTH REMOVAL OF TESTIS ABDOMINAL","code_information":[{"code":"Px00096310101","type":"CDM"},{"code":"00928","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00930 ANESTH TESTIS SUSPENSION","code_information":[{"code":"Px00096310102","type":"CDM"},{"code":"00930","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00938 ANESTH INSERT PENIS DEVICE","code_information":[{"code":"Px00096310103","type":"CDM"},{"code":"00938","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00940 ANESTH VAGINAL PROCEDURES","code_information":[{"code":"Px00096310104","type":"CDM"},{"code":"00940","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00942 ANESTH SURG ON VAG/URETHRAL","code_information":[{"code":"Px00096310105","type":"CDM"},{"code":"00942","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00944 ANESTH VAGINAL HYSTERECTOMY","code_information":[{"code":"Px00096310106","type":"CDM"},{"code":"00944","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00948 ANESTH REPAIR OF CERVIX","code_information":[{"code":"Px00096310107","type":"CDM"},{"code":"00948","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00950 ANESTH VAGINAL ENDOSCOPY","code_information":[{"code":"Px00096310108","type":"CDM"},{"code":"00950","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00952 ANESTH HYSTEROSCOPE/GRAPH","code_information":[{"code":"Px00096310109","type":"CDM"},{"code":"00952","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01112 ANESTH BONE ASPIRATE/BX","code_information":[{"code":"Px00096310110","type":"CDM"},{"code":"01112","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01120 ANESTH PELVIS SURGERY","code_information":[{"code":"Px00096310111","type":"CDM"},{"code":"01120","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01200 ANESTH HIP JOINT PROCEDURE","code_information":[{"code":"Px00096310112","type":"CDM"},{"code":"01200","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01202 ANESTH ARTHROSCOPY OF HIP","code_information":[{"code":"Px00096310113","type":"CDM"},{"code":"01202","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01210 ANESTH HIP JOINT SURGERY","code_information":[{"code":"Px00096310114","type":"CDM"},{"code":"01210","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01212 ANESTH HIP DISARTICULATION","code_information":[{"code":"Px00096310115","type":"CDM"},{"code":"01212","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01214 ANESTH HIP ARTHROPLASTY","code_information":[{"code":"Px00096310116","type":"CDM"},{"code":"01214","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01215 ANESTH REVISE HIP REPAIR","code_information":[{"code":"Px00096310117","type":"CDM"},{"code":"01215","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01220 ANESTH PROCEDURE ON FEMUR","code_information":[{"code":"Px00096310118","type":"CDM"},{"code":"01220","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01230 ANESTH SURGERY OF FEMUR","code_information":[{"code":"Px00096310119","type":"CDM"},{"code":"01230","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01232 ANESTH AMPUTATION OF FEMUR","code_information":[{"code":"Px00096310120","type":"CDM"},{"code":"01232","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01234 ANESTH RADICAL FEMUR SURG","code_information":[{"code":"Px00096310121","type":"CDM"},{"code":"01234","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01250 ANESTH UPPER LEG SURGERY","code_information":[{"code":"Px00096310122","type":"CDM"},{"code":"01250","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01260 ANESTH UPPER LEG VEINS SURG","code_information":[{"code":"Px00096310123","type":"CDM"},{"code":"01260","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01270 ANESTH THIGH ARTERIES SURG","code_information":[{"code":"Px00096310124","type":"CDM"},{"code":"01270","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01272 ANESTH FEMORAL ARTERY SURG","code_information":[{"code":"Px00096310125","type":"CDM"},{"code":"01272","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01274 ANESTH FEMORAL EMBOLECTOMY","code_information":[{"code":"Px00096310126","type":"CDM"},{"code":"01274","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01320 ANESTH KNEE AREA SURGERY","code_information":[{"code":"Px00096310127","type":"CDM"},{"code":"01320","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01340 ANESTH KNEE AREA PROCEDURE","code_information":[{"code":"Px00096310128","type":"CDM"},{"code":"01340","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01360 ANESTH KNEE AREA SURGERY","code_information":[{"code":"Px00096310129","type":"CDM"},{"code":"01360","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01380 ANESTH KNEE JOINT PROCEDURE","code_information":[{"code":"Px00096310130","type":"CDM"},{"code":"01380","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01382 ANESTH DX KNEE ARTHROSCOPY","code_information":[{"code":"Px00096310131","type":"CDM"},{"code":"01382","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01390 ANESTH KNEE AREA PROCEDURE","code_information":[{"code":"Px00096310132","type":"CDM"},{"code":"01390","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01392 ANESTH KNEE AREA SURGERY TIB/FIB/UPPER","code_information":[{"code":"Px00096310133","type":"CDM"},{"code":"01392","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01400 ANESTH KNEE AREA SURGERY ARTHROSCOPY","code_information":[{"code":"Px00096310134","type":"CDM"},{"code":"01400","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01402 ANESTH TOTAL KNEE ARTHROPLASTY","code_information":[{"code":"Px00096310135","type":"CDM"},{"code":"01402","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01404 ANESTH AMPUTATION AT KNEE","code_information":[{"code":"Px00096310136","type":"CDM"},{"code":"01404","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01420 ANESTH KNEE JOINT CASTING","code_information":[{"code":"Px00096310137","type":"CDM"},{"code":"01420","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01430 ANESTH KNEE VEINS SURGERY","code_information":[{"code":"Px00096310138","type":"CDM"},{"code":"01430","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01440 ANESTH KNEE ARTERIES SURG","code_information":[{"code":"Px00096310139","type":"CDM"},{"code":"01440","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01442 ANESTH KNEE ARTERY SURG","code_information":[{"code":"Px00096310140","type":"CDM"},{"code":"01442","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01444 ANESTH KNEE ARTERY REPAIR","code_information":[{"code":"Px00096310141","type":"CDM"},{"code":"01444","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01462 ANESTH LOWER LEG PROCEDURE","code_information":[{"code":"Px00096310142","type":"CDM"},{"code":"01462","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01464 ANESTH ANKLE/FT ARTHROSCOPY","code_information":[{"code":"Px00096310143","type":"CDM"},{"code":"01464","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01470 ANESTH LOWER LEG SURGERY","code_information":[{"code":"Px00096310144","type":"CDM"},{"code":"01470","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01472 ANESTH ACHILLES TENDON SURG","code_information":[{"code":"Px00096310145","type":"CDM"},{"code":"01472","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01474 ANESTH LOWER LEG SURGERY","code_information":[{"code":"Px00096310146","type":"CDM"},{"code":"01474","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01480 ANESTH LOWER LEG BONE SURG","code_information":[{"code":"Px00096310147","type":"CDM"},{"code":"01480","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01482 ANESTH RADICAL LEG SURGERY","code_information":[{"code":"Px00096310148","type":"CDM"},{"code":"01482","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01484 ANESTH LOWER LEG REVISION","code_information":[{"code":"Px00096310149","type":"CDM"},{"code":"01484","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01486 ANESTH ANKLE REPLACEMENT","code_information":[{"code":"Px00096310150","type":"CDM"},{"code":"01486","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01490 ANESTH LOWER LEG CASTING","code_information":[{"code":"Px00096310151","type":"CDM"},{"code":"01490","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01500 ANESTH LEG ARTERIES SURG","code_information":[{"code":"Px00096310152","type":"CDM"},{"code":"01500","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01502 ANESTH LWR LEG EMBOLECTOMY","code_information":[{"code":"Px00096310153","type":"CDM"},{"code":"01502","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01520 ANESTH LOWER LEG VEIN SURG","code_information":[{"code":"Px00096310154","type":"CDM"},{"code":"01520","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01522 ANESTH LOWER LEG VEIN SURG-THROMBECTOMY","code_information":[{"code":"Px00096310155","type":"CDM"},{"code":"01522","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01610 ANESTH SURGERY OF SHOULDER AND AXILLA","code_information":[{"code":"Px00096310156","type":"CDM"},{"code":"01610","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01620 ANESTH SHOULDER PROCEDURE","code_information":[{"code":"Px00096310157","type":"CDM"},{"code":"01620","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01622 ANES DX SHOULDER ARTHROSCOPY","code_information":[{"code":"Px00096310158","type":"CDM"},{"code":"01622","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01630 ANESTH SURGERY OF SHOULDER OPEN OR SURGICAL ARTHRO","code_information":[{"code":"Px00096310159","type":"CDM"},{"code":"01630","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01634 ANESTH SHOULDER JOINT AMPUT","code_information":[{"code":"Px00096310160","type":"CDM"},{"code":"01634","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01638 ANESTH SHOULDER REPLACEMENT","code_information":[{"code":"Px00096310161","type":"CDM"},{"code":"01638","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01650 ANESTH SHOULDER ARTERY SURG","code_information":[{"code":"Px00096310162","type":"CDM"},{"code":"01650","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01680 ANESTH SHOULDER CASTING","code_information":[{"code":"Px00096310163","type":"CDM"},{"code":"01680","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01710 ANESTH ELBOW AREA SURGERY","code_information":[{"code":"Px00096310165","type":"CDM"},{"code":"01710","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01712 ANESTH UPPR ARM TENDON OPEN SURG","code_information":[{"code":"Px00096310166","type":"CDM"},{"code":"01712","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01714 ANESTH UPPR ARM TENOPLASTY","code_information":[{"code":"Px00096310167","type":"CDM"},{"code":"01714","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01716 ANESTH BICEPS TENDON REPAIR","code_information":[{"code":"Px00096310168","type":"CDM"},{"code":"01716","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01730 ANESTH UPPR ARM PROCEDURE","code_information":[{"code":"Px00096310169","type":"CDM"},{"code":"01730","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01732 ANESTH DX ELBOW ARTHROSCOPY","code_information":[{"code":"Px00096310170","type":"CDM"},{"code":"01732","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01740 ANESTH UPPER ARM SURGERY","code_information":[{"code":"Px00096310171","type":"CDM"},{"code":"01740","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01742 ANESTH HUMERUS SURGERY","code_information":[{"code":"Px00096310172","type":"CDM"},{"code":"01742","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01744 ANESTH HUMERUS REPAIR","code_information":[{"code":"Px00096310173","type":"CDM"},{"code":"01744","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01758 ANESTH HUMERAL LESION SURG","code_information":[{"code":"Px00096310174","type":"CDM"},{"code":"01758","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01760 ANESTH ELBOW REPLACEMENT","code_information":[{"code":"Px00096310175","type":"CDM"},{"code":"01760","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01770 ANESTH UPPR ARM ARTERY SURG","code_information":[{"code":"Px00096310176","type":"CDM"},{"code":"01770","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01772 ANESTH UPPR ARM EMBOLECTOMY","code_information":[{"code":"Px00096310177","type":"CDM"},{"code":"01772","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01780 ANESTH UPPER ARM VEIN SURG","code_information":[{"code":"Px00096310178","type":"CDM"},{"code":"01780","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01810 ANESTH LOWER ARM SURGERY","code_information":[{"code":"Px00096310179","type":"CDM"},{"code":"01810","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01820 ANESTH LOWER ARM PROCEDURE","code_information":[{"code":"Px00096310180","type":"CDM"},{"code":"01820","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01829 ANESTH DX WRIST ARTHROSCOPY","code_information":[{"code":"Px00096310181","type":"CDM"},{"code":"01829","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01830 ANESTH LOWER ARM SURGERY","code_information":[{"code":"Px00096310182","type":"CDM"},{"code":"01830","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01832 ANESTH WRIST REPLACEMENT","code_information":[{"code":"Px00096310183","type":"CDM"},{"code":"01832","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01840 ANESTH LWR ARM ARTERY SURG","code_information":[{"code":"Px00096310184","type":"CDM"},{"code":"01840","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01842 ANESTH LWR ARM EMBOLECTOMY","code_information":[{"code":"Px00096310185","type":"CDM"},{"code":"01842","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01844 ANESTH VASCULAR SHUNT SURG","code_information":[{"code":"Px00096310186","type":"CDM"},{"code":"01844","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01850 ANESTH LOWER ARM VEIN SURG","code_information":[{"code":"Px00096310187","type":"CDM"},{"code":"01850","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01860 ANESTH LOWER ARM CASTING","code_information":[{"code":"Px00096310188","type":"CDM"},{"code":"01860","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01916 ANESTH DX ARTERIOGRAPHY","code_information":[{"code":"Px00096310189","type":"CDM"},{"code":"01916","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01922 ANESTH CAT OR MRI SCAN","code_information":[{"code":"Px00096310190","type":"CDM"},{"code":"01922","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01958 ANESTH ANTEPARTUM MANIPUL","code_information":[{"code":"Px00096310193","type":"CDM"},{"code":"01958","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01960 ANESTH VAGINAL DELIVERY","code_information":[{"code":"Px00096310194","type":"CDM"},{"code":"01960","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01961 ANESTH CS DELIVERY","code_information":[{"code":"Px00096310195","type":"CDM"},{"code":"01961","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01962 ANESTH EMER HYSTERECTOMY","code_information":[{"code":"Px00096310196","type":"CDM"},{"code":"01962","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01963 ANESTH CS HYSTERECTOMY","code_information":[{"code":"Px00096310197","type":"CDM"},{"code":"01963","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01965 ANESTH INC/MISSED AB PROC","code_information":[{"code":"Px00096310198","type":"CDM"},{"code":"01965","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01967 ANESTH/ANALG VAG DELIVERY","code_information":[{"code":"Px00096310199","type":"CDM"},{"code":"01967","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01968 ANES/ANALG CS DELIVER ADD-ON","code_information":[{"code":"Px00096310200","type":"CDM"},{"code":"01968","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01969 ANESTH/ANALG CS HYST ADD-ON","code_information":[{"code":"Px00096310201","type":"CDM"},{"code":"01969","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01990 SUPPORT FOR ORGAN DONOR","code_information":[{"code":"Px00096310202","type":"CDM"},{"code":"01990","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01991 ANESTH NERVE BLOCK/INJ","code_information":[{"code":"Px00096310203","type":"CDM"},{"code":"01991","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01992 ANESTH N BLOCK/INJ PRONE","code_information":[{"code":"Px00096310204","type":"CDM"},{"code":"01992","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01996 HOSP MANAGE CONT DRUG ADMIN AA","code_information":[{"code":"Px00096310205","type":"CDM"},{"code":"01996","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 01999 UNLISTED ANESTH PROCEDURE","code_information":[{"code":"Px00096310206","type":"CDM"},{"code":"01999","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 64450 NERVE BLOCK OTHER PERIPHERAL SEPARATE PROC","code_information":[{"code":"Px00096310215","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 31500 INTUBATION W/BRONCHOSCOPE","code_information":[{"code":"Px00096310220","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 36400 VNPNXR/YOUNGER THAN 3YRS PHY/QHP SKILL FEM/JUGLAR VEIN","code_information":[{"code":"Px00096310221","type":"CDM"},{"code":"36400","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 36620 ANES/ARTERIAL CATH/CANNULA","code_information":[{"code":"Px00096310223","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 62270 ANES/SPINAL PUNC","code_information":[{"code":"Px00096310224","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 64425 ANES ILIOINGUINAL NERVE","code_information":[{"code":"Px00096310226","type":"CDM"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 36556 INSERT NON-TUNNEL CV CATH > 5","code_information":[{"code":"Px00096310231","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 36569 INSERTION PICC W/O IMG GDN 5 YR/>","code_information":[{"code":"Px00096310232","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":154.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 36410 NON-ROUTINE BL DRAW > 3 YRS","code_information":[{"code":"Px00096310233","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":32.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 36584 COMPLETE REPLACEMENT PICC RS&I","code_information":[{"code":"Px00096310242","type":"CDM"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 62320 INJ INTERLAMINAR CRV/THRC W/O IMG","code_information":[{"code":"Px00096310267","type":"CDM"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 62324 INJ INTRALAMINAR CRV/THRC W/O IMG","code_information":[{"code":"Px00096310268","type":"CDM"},{"code":"62324","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 62326 INJ INTERLAMINAR LMBR/SAC W/O IMG","code_information":[{"code":"Px00096310269","type":"CDM"},{"code":"62326","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 62322 INJ INTERLAMINAR LMBR/SAC W/O IMG","code_information":[{"code":"Px00096310270","type":"CDM"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00731 ANES UPPR GI NDSC PX NOS","code_information":[{"code":"Px00096310282","type":"CDM"},{"code":"00731","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00732 ANES UPR GI NDSC PX ERCP","code_information":[{"code":"Px00096310283","type":"CDM"},{"code":"00732","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00811 ANES LWR INTST NDSC NOS","code_information":[{"code":"Px00096310284","type":"CDM"},{"code":"00811","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00812 ANES LWR INTST SCR COLSC","code_information":[{"code":"Px00096310285","type":"CDM"},{"code":"00812","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 00813 ANES UPPR LWR GI NDSC PX","code_information":[{"code":"Px00096310286","type":"CDM"},{"code":"00813","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Base Price)"},{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99304 INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN CDM","code_information":[{"code":"Px00096910101","type":"CDM"},{"code":"99304","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99305 INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES CDM","code_information":[{"code":"Px00096910102","type":"CDM"},{"code":"99305","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":222.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99306 INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES","code_information":[{"code":"Px00096910103","type":"CDM"},{"code":"99306","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":280.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99307 SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES CDM","code_information":[{"code":"Px00096910104","type":"CDM"},{"code":"99307","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99308 SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES","code_information":[{"code":"Px00096910105","type":"CDM"},{"code":"99308","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99309 SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES CDM","code_information":[{"code":"Px00096910106","type":"CDM"},{"code":"99309","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99310 SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES CDM","code_information":[{"code":"Px00096910107","type":"CDM"},{"code":"99310","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":226.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99315 NURSING FACILITY DISCHARGE MGMT 30 MINS/OR LESS TOTAL CDM","code_information":[{"code":"Px00096910108","type":"CDM"},{"code":"99315","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99316 NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME CDM","code_information":[{"code":"Px00096910109","type":"CDM"},{"code":"99316","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99358 PROLONG SERVICE W/O CONTACT FIRST HOUR","code_information":[{"code":"Px00096910130","type":"CDM"},{"code":"99358","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":214.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99359 PROLONGED SERVICE NON FACE TO FACE CONTACT EA ADDL 30 MIN","code_information":[{"code":"Px00096910131","type":"CDM"},{"code":"99359","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":104.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99383 PREV VISIT NEW AGE 5-11","code_information":[{"code":"Px00096910149","type":"CDM"},{"code":"99383","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 43246 EGD PLACE GASTROSTOMY TUBE","code_information":[{"code":"Px00096910212","type":"CDM"},{"code":"43246","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 51705 CHANGE CYSTOSTOMY TUBE SIMPLE","code_information":[{"code":"Px00096910238","type":"CDM"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 96372 THER/PROPH/DIAG INJ SC/IM","code_information":[{"code":"Px00096910474","type":"CDM"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 11900 INJECTION INTO SKIN LESIONS","code_information":[{"code":"Px00096910501","type":"CDM"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 25028 DRAINAGE OF FOREARM LESION","code_information":[{"code":"Px00096910549","type":"CDM"},{"code":"25028","type":"HCPCS"}],"standard_charges":[{"gross_charge":1496.0,"discounted_cash":1047.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99465 CRITICAL CARE - NEWBORN","code_information":[{"code":"Px00096910634","type":"CDM"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 26125 RELEASE PALM CONTRACTURE ADD","code_information":[{"code":"Px00096910730","type":"CDM"},{"code":"26125","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":555.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 27825 CLOSED TREAT LOWER LEG FRACTURE W/MANIP","code_information":[{"code":"Px00096910781","type":"CDM"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":1221.0,"discounted_cash":854.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":1421.0,"discounted_cash":994.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR 57200 REPAIR OF VAGINA, SUTURE","code_information":[{"code":"Px00096910841","type":"CDM"},{"code":"57200","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.0,"discounted_cash":522.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":868.0,"discounted_cash":607.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR 64405 NERVE BLOCK INJ OCCIPITAL","code_information":[{"code":"Px00096910857","type":"CDM"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":178.0,"discounted_cash":124.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR 64425 NERVE BLOCK INJ ILIOINGUINAL","code_information":[{"code":"Px00096910858","type":"CDM"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45388 COLONOSCOPY W/ABLATION","code_information":[{"code":"Px00096911103","type":"CDM"},{"code":"45388","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":545.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45390 COLONOSCOPY W/RESECTION","code_information":[{"code":"Px00096911105","type":"CDM"},{"code":"45390","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88108 CYTP CONCENTRATION SMEARS & INTERPRETATION #","code_information":[{"code":"Px00097100001","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88313 SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT #","code_information":[{"code":"Px00097100005","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 80503 PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN #","code_information":[{"code":"Px00097100006","type":"CDM"},{"code":"80503","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 80503 PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN CDM","code_information":[{"code":"Px00097100010","type":"CDM"},{"code":"80503","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 87207 SMR PRIM SRC SPEC STAIN BODIES/PARASITS CDM","code_information":[{"code":"Px00097100011","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 38220 DX BONE MARROW ASPIRATIONS","code_information":[{"code":"Px00097110001","type":"CDM"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 38221 DX BONE MARROW BIOPSIES","code_information":[{"code":"Px00097110002","type":"CDM"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":125.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88104 BILL CYTO NON-GYN","code_information":[{"code":"Px00097110014","type":"CDM"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88311 BILL SURG DECAL","code_information":[{"code":"Px00097110019","type":"CDM"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE #","code_information":[{"code":"Px00097110028","type":"CDM"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88312 BILL SURG STAINS GROUP 1","code_information":[{"code":"Px00097110047","type":"CDM"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88313 BILL SURG STAINS GROUP 2","code_information":[{"code":"Px00097110048","type":"CDM"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88187 FLOW CYTO 2-8 MARKERS","code_information":[{"code":"Px00097110053","type":"CDM"},{"code":"88187","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88188 FLOW CYTO 9-15 MARKERS","code_information":[{"code":"Px00097110054","type":"CDM"},{"code":"88188","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88189 FLOW CYTO GT 16 MARKERS","code_information":[{"code":"Px00097110055","type":"CDM"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88108 FLUID WASH BRUSH CONC","code_information":[{"code":"Px00097110058","type":"CDM"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88365 IN SITU HYBRIDIZATION","code_information":[{"code":"Px00097110060","type":"CDM"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 85060 BLOOD SMEAR INTERPRETATION","code_information":[{"code":"Px00097110120","type":"CDM"},{"code":"85060","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88341 IMMUNOHISTO ANTIBODY SLIDE EA ADDL","code_information":[{"code":"Px00097110163","type":"CDM"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88364 INSITU HYBRIDIZATION (FISH) EACH ADDL","code_information":[{"code":"Px00097110165","type":"CDM"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":219.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 87207 SMEAR SPECIAL STAIN","code_information":[{"code":"Px00097110223","type":"CDM"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 88305 TISSUE EXAM BY PATHOLOGIST","code_information":[{"code":"Px00097110230","type":"CDM"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 76937 US GUIDE VASCULAR ACCESS","code_information":[{"code":"Px00097210015","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR G0105 COLORECTAL SCRN HI RISK IND","code_information":[{"code":"Px00097510012","type":"CDM"},{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":443.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR G0121 COLORECTAL SCRN NOT HI RISK IND","code_information":[{"code":"Px00097510013","type":"CDM"},{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":443.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 97597 DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/OR LESS","code_information":[{"code":"Px00097510016","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":133.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 11012 DEB SKIN BONE AT FX SITE","code_information":[{"code":"Px00097510036","type":"CDM"},{"code":"11012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1228.0,"discounted_cash":859.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 43255 EGD CONTROL BLEEDING ANY","code_information":[{"code":"Px00097510144","type":"CDM"},{"code":"43255","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":576.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 31622 BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX CDM","code_information":[{"code":"Px00097510182","type":"CDM"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":296.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 31624 DX BRONCHOSCOPE/LAVAGE","code_information":[{"code":"Px00097510184","type":"CDM"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 31625 BRONCHOSCOPY W/BIOPSY(S)","code_information":[{"code":"Px00097510185","type":"CDM"},{"code":"31625","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 43215 ESOPHAGOSCOPY FLEX REMOVE FB","code_information":[{"code":"Px00097510289","type":"CDM"},{"code":"43215","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":453.0,"discounted_cash":317.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR 43235 EGD DIAGNOSTIC BRUSH WASH","code_information":[{"code":"Px00097510294","type":"CDM"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 43236 UPPER GI SCOPE W/SUBMUC INJ","code_information":[{"code":"Px00097510295","type":"CDM"},{"code":"43236","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":358.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 43239 EGD BIOPSY SINGLE/MULTIPLE","code_information":[{"code":"Px00097510296","type":"CDM"},{"code":"43239","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":350.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR DX BONE MARROW BX & ASPIR","code_information":[{"code":"Px00097510300","type":"CDM"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 13160 LATE CLOSURE OF WOUND EXTENSIVE OR COMPLICATED","code_information":[{"code":"Px00097510301","type":"CDM"},{"code":"13160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2229.0,"discounted_cash":1560.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 20612 ASPIRATE/INJ GANGLION CYST","code_information":[{"code":"Px00097510383","type":"CDM"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 43247 OPERATIVE UPPER GI ENDOSCOPY W/ FB REMOVAL","code_information":[{"code":"Px00097510501","type":"CDM"},{"code":"43247","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":409.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 43248 EGD GUIDE WIRE INSERTION","code_information":[{"code":"Px00097510502","type":"CDM"},{"code":"43248","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":326.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 43249 EGD BALLOON DILATION ESOPHAGUS/LESS THAN 30MM","code_information":[{"code":"Px00097510503","type":"CDM"},{"code":"43249","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":354.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 43450 DILATE ESOPHAGUS, UNGUIDED","code_information":[{"code":"Px00097510529","type":"CDM"},{"code":"43450","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":182.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 44388 DX COLONOSCOPY THRU STOMA INCLUDING COLLTN SPEC SP PRCD CDM","code_information":[{"code":"Px00097510717","type":"CDM"},{"code":"44388","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":340.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 44389 COLONOSCOPY THRU STOMA W/BIOPSY SINGLE/MULTIPLE CDM","code_information":[{"code":"Px00097510718","type":"CDM"},{"code":"44389","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":378.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 44390 COLONOSCOPY THRU STOMA W/RMVL FOREIGN BODY CDM","code_information":[{"code":"Px00097510719","type":"CDM"},{"code":"44390","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.0,"discounted_cash":464.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 44391 COLONOSCOPY THRU STOMA W/ CONTROL BLEEDING CDM","code_information":[{"code":"Px00097510720","type":"CDM"},{"code":"44391","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":514.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 44392 COLONOSCOPY THRU STOMA RMVL LES BY HOT BIOPSY FORCEPS CDM","code_information":[{"code":"Px00097510721","type":"CDM"},{"code":"44392","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":451.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 44394 COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE CDM","code_information":[{"code":"Px00097510723","type":"CDM"},{"code":"44394","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":523.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45330 DIAGNOSTIC SIGMOIDOSCOPY","code_information":[{"code":"Px00097510758","type":"CDM"},{"code":"45330","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45331 SIGMOIDOSCOPY AND BIOPSY","code_information":[{"code":"Px00097510759","type":"CDM"},{"code":"45331","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45333 SIGMOIDOSCOPY & POLYPECTOMY","code_information":[{"code":"Px00097510761","type":"CDM"},{"code":"45333","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 46608 ANOSCOPY REMOVE FOR BODY","code_information":[{"code":"Px00097510762","type":"CDM"},{"code":"46608","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":141.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45338 SIGMOIDOSCOPY W/TUMOR REMOVAL","code_information":[{"code":"Px00097510765","type":"CDM"},{"code":"45338","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":289.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45378 DX COLONOSCOPY FLEXIBLE W/COLLTN SPEC WHEN PFRMD CDM","code_information":[{"code":"Px00097510766","type":"CDM"},{"code":"45378","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":443.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45379 COLONOSCOPY W/FB REMOVAL","code_information":[{"code":"Px00097510767","type":"CDM"},{"code":"45379","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":553.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45380 COLONOSCOPY FLEXIBLE W/BIOPSY SINGLE/MULTIPLE CDM","code_information":[{"code":"Px00097510768","type":"CDM"},{"code":"45380","type":"HCPCS"}],"standard_charges":[{"gross_charge":757.0,"discounted_cash":529.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45381 COLONOSCOPY SUBMUCOUS INJ","code_information":[{"code":"Px00097510769","type":"CDM"},{"code":"45381","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.0,"discounted_cash":502.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45382 COLONOSCOPY/CONTROL BLEEDING","code_information":[{"code":"Px00097510770","type":"CDM"},{"code":"45382","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":674.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45384 LESION REMOVE COLONOSCOPY","code_information":[{"code":"Px00097510772","type":"CDM"},{"code":"45384","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":553.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM","code_information":[{"code":"Px00097510773","type":"CDM"},{"code":"45385","type":"HCPCS"}],"standard_charges":[{"gross_charge":898.0,"discounted_cash":628.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 45900 REDUCTION OF RECTAL PROLAPSE","code_information":[{"code":"Px00097510780","type":"CDM"},{"code":"45900","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":403.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 43245 EGD DILATE STRICTURE","code_information":[{"code":"Px00097511161","type":"CDM"},{"code":"43245","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC","code_information":[{"code":"Px00097511246","type":"CDM"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR 43763 PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC","code_information":[{"code":"Px00097511247","type":"CDM"},{"code":"43763","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR 36572 INSERTION PICC W/RS&I/YOUNGER THAN 5 YEARS","code_information":[{"code":"Px00097511290","type":"CDM"},{"code":"36572","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":215.0,"discounted_cash":150.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 36573 INSERTION PICC W/RS&I 5 YR/>","code_information":[{"code":"Px00097511291","type":"CDM"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 32554 THORANCENTESIS NEEDLE/CATH PLEURA W/O IMAGING","code_information":[{"code":"Px00097511404","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 62380 ENDOSC DCMP 1 SPACE LUM","code_information":[{"code":"Px00097513744","type":"CDM"},{"code":"62380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":801.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE  CDM","code_information":[{"code":"Px00097513992","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 94060 SPIROMETRY PRE POST BRONCHODILATOR","code_information":[{"code":"Px00097610003","type":"CDM"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 94070 BRONCHIAL PROVOCATION","code_information":[{"code":"Px00097610007","type":"CDM"},{"code":"94070","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 94729 DIFFUSING CAPACITY","code_information":[{"code":"Px00097610009","type":"CDM"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 94010 SPIROMETRY","code_information":[{"code":"Px00097610016","type":"CDM"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 94726 BODY PLETHYSMOGRAPHY","code_information":[{"code":"Px00097610027","type":"CDM"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 11200 REMOVAL OF SKIN TAGS CDM","code_information":[{"code":"Px00098100014","type":"CDM"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":154.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20611 DRAIN/INJ JOINT/BURSA MAJOR W/US CDM","code_information":[{"code":"Px00098100032","type":"CDM"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 15853 REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA CDM","code_information":[{"code":"Px00098100097","type":"CDM"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 35860 EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR CDM","code_information":[{"code":"Px00098100105","type":"CDM"},{"code":"35860","type":"HCPCS"}],"standard_charges":[{"gross_charge":2390.0,"discounted_cash":1673.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27385 SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY CDM","code_information":[{"code":"Px00098100123","type":"CDM"},{"code":"27385","type":"HCPCS"}],"standard_charges":[{"gross_charge":2006.0,"discounted_cash":1404.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99283 VISIT LOW MDM CDM","code_information":[{"code":"Px00098110009","type":"CDM"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99284 VISIT MODERATE MDM CDM","code_information":[{"code":"Px00098110012","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99285 VISIT HIGH MDM CDM","code_information":[{"code":"Px00098110016","type":"CDM"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":326.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 92511 NASPHARYNGOSCOPY CDM","code_information":[{"code":"Px00098110018","type":"CDM"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM","code_information":[{"code":"Px00098110021","type":"CDM"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99292 CRITICAL CARE ADDL 30 MIN CDM","code_information":[{"code":"Px00098110023","type":"CDM"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":219.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99309 SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES CDM","code_information":[{"code":"Px00098110047","type":"CDM"},{"code":"99309","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC CDM","code_information":[{"code":"Px00098110057","type":"CDM"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 11012 DEBRIDE ASSOC OPEN FX/DISLO SKIN/MUS/BONE CDM","code_information":[{"code":"Px00098110093","type":"CDM"},{"code":"11012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.0,"discounted_cash":742.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 92953 TEMP TRANSCUTANEOUS EXT PACING CDM","code_information":[{"code":"Px00098110101","type":"CDM"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM","code_information":[{"code":"Px00098110102","type":"CDM"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23030 DRAIN SHOULDER LESION CDM","code_information":[{"code":"Px00098110113","type":"CDM"},{"code":"23030","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":511.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 31628 BRONCHOSCOPY/LUNG BX EACH CDM","code_information":[{"code":"Px00098110114","type":"CDM"},{"code":"31628","type":"HCPCS"}],"standard_charges":[{"gross_charge":546.0,"discounted_cash":382.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 49451 REPLACE DUOD/JEJ TUBE PERC CDM","code_information":[{"code":"Px00098110115","type":"CDM"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":267.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED G0260 INJ FOR SACROILIAC JT ANESTH CDM","code_information":[{"code":"Px00098110116","type":"CDM"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27197 CLOSED TX PELVIC RING FX W/O MANIP CDM","code_information":[{"code":"Px00098110141","type":"CDM"},{"code":"27197","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":801.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27198 CLOSED TX PELVIC RING FX W/MANIP CDM","code_information":[{"code":"Px00098110142","type":"CDM"},{"code":"27198","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":801.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99152 MOD SED SAME PHYS/QHP 5/>YRS 1ST 15 MIN CDM","code_information":[{"code":"Px00098110145","type":"CDM"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99153 MOD SED SAME PHYS/QHP EA ADDL 15 MIN CDM","code_information":[{"code":"Px00098110146","type":"CDM"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99155 MOD SED OTHER PHYS/QHP INITIAL 15 MINS/YOUNGER THAN 5YRS CDM","code_information":[{"code":"Px00098110147","type":"CDM"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99157 MOD SED OTHER PHYS/QHP EA ADDL 15 MIN CDM","code_information":[{"code":"Px00098110148","type":"CDM"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99156 MOD SED OTH PHYS/QHP 5/>YRS 1ST 15 MIN CDM","code_information":[{"code":"Px00098110149","type":"CDM"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":291.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 97597 DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/OR LESS","code_information":[{"code":"Px00098110157","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36555 INSJ NON-TUNNELED CENTRAL VENOUS CATH/YOUNGER THAN 5 YRS CDM","code_information":[{"code":"Px00098110224","type":"CDM"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":351.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36680 INSERT NEEDLE BONE CAVITY CDM","code_information":[{"code":"Px00098110226","type":"CDM"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM","code_information":[{"code":"Px00098110229","type":"CDM"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":189.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 10061 DRAINAGE OF SKIN ABSCESS COMPLICATED OR MULTIPLE CDM","code_information":[{"code":"Px00098110231","type":"CDM"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 10080 DRAINAGE OF PILONIDAL CYST SIMPLE CDM","code_information":[{"code":"Px00098110232","type":"CDM"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":203.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 10081 DRAINAGE OF PILONIDAL CYST COMPLICATED CDM","code_information":[{"code":"Px00098110233","type":"CDM"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":343.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 10120 REMOVE FOREIGN BODY SIMPLE CDM","code_information":[{"code":"Px00098110234","type":"CDM"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 10121 REMOVE FOREIGN BODY COMPLICATED CDM","code_information":[{"code":"Px00098110235","type":"CDM"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 10140 DRAINAGE OF HEMATOMA/FLUID CDM","code_information":[{"code":"Px00098110236","type":"CDM"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":235.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST CDM","code_information":[{"code":"Px00098110238","type":"CDM"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 11042 DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS CDM","code_information":[{"code":"Px00098110242","type":"CDM"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 11730 REMOVAL OF NAIL PLATE CDM","code_information":[{"code":"Px00098110251","type":"CDM"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 11740 DRAIN BLOOD FROM UNDER NAIL CDM","code_information":[{"code":"Px00098110253","type":"CDM"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 11750 REMOVAL OF NAIL BED CDM","code_information":[{"code":"Px00098110254","type":"CDM"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 11760 REPAIR OF NAIL BED CDM","code_information":[{"code":"Px00098110256","type":"CDM"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 11765 EXCISION OF NAIL FOLD TOE CDM","code_information":[{"code":"Px00098110258","type":"CDM"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM","code_information":[{"code":"Px00098110259","type":"CDM"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12002 REPAIR SUPERFIC WOUND(S) 2.6 TO 7.5CM SLP NK AX EXGEN T CDM","code_information":[{"code":"Px00098110260","type":"CDM"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12004 REPAIR SUPERFIC WOUND(S)7.6 TO 12.5CM SLP NK AX EXGEN T CDM","code_information":[{"code":"Px00098110261","type":"CDM"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12005 REPAIR SUPERFIC WOUND(S)12.6 TO 20.0CM SLP NK AX EXGEN CDM","code_information":[{"code":"Px00098110262","type":"CDM"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":213.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12006 REPAIR SUPERFIC WOUND(S) 20.1-30.0CM SLP NK AX EXGEN TR CDM","code_information":[{"code":"Px00098110263","type":"CDM"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12007 REPAIR SUPERFIC WOUND(S) >30CM SLP NK AX EXGEN TRNK EXT CDM","code_information":[{"code":"Px00098110264","type":"CDM"},{"code":"12007","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":399.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM","code_information":[{"code":"Px00098110265","type":"CDM"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12013 REPAIR SUPERFIC WOUND(S) 2.6 TO 5.0CM FACE ERS EYLD NSE CDM","code_information":[{"code":"Px00098110266","type":"CDM"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12014 REPAIR SUPERFIC WOUND(S) 5.1 TO 7.5CM FACE ERS EYLD NSE CDM","code_information":[{"code":"Px00098110267","type":"CDM"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12015 REPAIR SUPERFIC WOUND(S) 7.6 TO 12.5CM FACE ERS EYLD NS CDM","code_information":[{"code":"Px00098110268","type":"CDM"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12016 REPAIR SUPERFIC WOUND(S) 12.6 TO 20.0CM FACE ERS EYLD N CDM","code_information":[{"code":"Px00098110269","type":"CDM"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":286.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12017 REPAIR SUPERFIC WOUND(S) 20.1 TO 30.0CM FACE ERS EYLD N CDM","code_information":[{"code":"Px00098110270","type":"CDM"},{"code":"12017","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12018 REPAIR SUPERFIC WOUND(S) >30.0 CM FACE ERS EYLD NSE LP CDM","code_information":[{"code":"Px00098110271","type":"CDM"},{"code":"12018","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12020 CLOSURE OF SPLIT WOUND SIMPLE CLOSURE CDM","code_information":[{"code":"Px00098110272","type":"CDM"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":375.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12021 CLOSURE OF SPLIT WOUND W/PACKNG CDM","code_information":[{"code":"Px00098110273","type":"CDM"},{"code":"12021","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":298.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM","code_information":[{"code":"Px00098110274","type":"CDM"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12032 INTMD WND REPAIR S/TR/EXT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00098110275","type":"CDM"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":394.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12034 INTMD WND REPAIR S/TR/EXT 7.6 TO 12.5CM CDM","code_information":[{"code":"Px00098110276","type":"CDM"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12035 INTMD WND REPAIR S/TR/EXT 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00098110277","type":"CDM"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":689.0,"discounted_cash":482.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12036 INTMD WND REPAIR S/TR/EXT 20.1 TO 30.0CM CDM","code_information":[{"code":"Px00098110278","type":"CDM"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":564.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12037 INTMD WND REPAIR S/TR/EXT > 30 CM. CDM","code_information":[{"code":"Px00098110279","type":"CDM"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":1166.0,"discounted_cash":816.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12041 INTMD WND REPAIR N-HF/GENIT UP TO 2.5CM CDM","code_information":[{"code":"Px00098110280","type":"CDM"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":315.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12042 INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM CDM","code_information":[{"code":"Px00098110281","type":"CDM"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":403.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12044 INTMD WND REPAIR N-HG/GENIT 7.6 TO 12.5CM CDM","code_information":[{"code":"Px00098110282","type":"CDM"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":431.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12045 INTMD WND REPAIR N-HG/GENIT 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00098110284","type":"CDM"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":531.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12046 INTMD WND REPAIR N-HG/GENIT 20.1-30.0CM CDM","code_information":[{"code":"Px00098110285","type":"CDM"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1342.0,"discounted_cash":939.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12047 INTMD WND REPAIR N-HG/GENIT >30.0CM CDM","code_information":[{"code":"Px00098110286","type":"CDM"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":1472.0,"discounted_cash":1030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12051 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/OR LESS CDM","code_information":[{"code":"Px00098110287","type":"CDM"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12052 INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM CDM","code_information":[{"code":"Px00098110288","type":"CDM"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":417.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12053 INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM CDM","code_information":[{"code":"Px00098110289","type":"CDM"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.0,"discounted_cash":438.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12054 INTMD WND REPAIR FACE/MM 7.5 TO 12.5CM CDM","code_information":[{"code":"Px00098110290","type":"CDM"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":461.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12055 INTMD WND REPAIR FACE/MM 12.6 TO 20.0CM CDM","code_information":[{"code":"Px00098110291","type":"CDM"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1183.0,"discounted_cash":828.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12057 INTMD WND REPAIR FACE/MM >30CM CDM","code_information":[{"code":"Px00098110293","type":"CDM"},{"code":"12057","type":"HCPCS"}],"standard_charges":[{"gross_charge":1379.0,"discounted_cash":965.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 13100 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMPLEX, TRUNK CDM","code_information":[{"code":"Px00098110294","type":"CDM"},{"code":"13100","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 13101 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX, TRUNK CDM","code_information":[{"code":"Px00098110295","type":"CDM"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 13120 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CPLX SCLP ARM L CDM","code_information":[{"code":"Px00098110297","type":"CDM"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":494.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 13121 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CPLX SCLP ARM L CDM","code_information":[{"code":"Px00098110298","type":"CDM"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":661.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 13122 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/OR LESS CDM","code_information":[{"code":"Px00098110299","type":"CDM"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":147.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 1040M ACCIDENT REPORT CDM","code_information":[{"code":"Px00098110304","type":"CDM"},{"code":"1040M","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 1048M RETURN TO WORK FORM CDM","code_information":[{"code":"Px00098110305","type":"CDM"},{"code":"1048M","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99080 SPECIAL REPORTS OR FORMS CDM","code_information":[{"code":"Px00098110307","type":"CDM"},{"code":"99080","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 30300 REMOVE NASAL FOREIGN BODY CDM","code_information":[{"code":"Px00098110316","type":"CDM"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":369.0,"discounted_cash":258.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 30901 CONTROL OF NOSEBLEED SIMPLE CDM","code_information":[{"code":"Px00098110317","type":"CDM"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":165.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 30903 CONTROL OF NOSEBLEED COMPLEX CDM","code_information":[{"code":"Px00098110319","type":"CDM"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 30905 CONTROL OF NOSEBLEED POSTERIOR CDM","code_information":[{"code":"Px00098110321","type":"CDM"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":294.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 31500 INS EMERGENCY AIRWAY CDM","code_information":[{"code":"Px00098110324","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 31502 CHANGE OF WINDPIPE AIRWAY CDM","code_information":[{"code":"Px00098110325","type":"CDM"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 31505 DIAGNOSTIC LARYNGOSCOPY INDIRECT CDM","code_information":[{"code":"Px00098110326","type":"CDM"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 31511 REMOVE FOREIGN BODY LARYNX CDM","code_information":[{"code":"Px00098110328","type":"CDM"},{"code":"31511","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 31515 LARYNGOSCOPY FOR ASPIRATION CDM","code_information":[{"code":"Px00098110329","type":"CDM"},{"code":"31515","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 31520 DX LARYNGOSCOPY NEWBORN CDM","code_information":[{"code":"Px00098110330","type":"CDM"},{"code":"31520","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 31525 DX LARYNGOSCOPY EXCL NEWBORN CDM","code_information":[{"code":"Px00098110331","type":"CDM"},{"code":"31525","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 31530 LARYNGOSCOPY W/FB REMOVAL CDM","code_information":[{"code":"Px00098110332","type":"CDM"},{"code":"31530","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 31575 DIAGNOSTIC LARYNGOSCOPY CDM","code_information":[{"code":"Px00098110333","type":"CDM"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":156.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 31577 REMOVE FOREIGN BODY LARYNX FLEXIBLE FIBEROPTIC CDM","code_information":[{"code":"Px00098110334","type":"CDM"},{"code":"31577","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 31603 TRACHEOSTOMY CDM","code_information":[{"code":"Px00098110335","type":"CDM"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.0,"discounted_cash":383.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 31605 CRICOTHYROIDOTOMY CDM","code_information":[{"code":"Px00098110336","type":"CDM"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":315.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 32110 EXPLORE/REPAIR CHEST CDM","code_information":[{"code":"Px00098110337","type":"CDM"},{"code":"32110","type":"HCPCS"}],"standard_charges":[{"gross_charge":3643.0,"discounted_cash":2550.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 32551 INSERTION OF CHEST TUBE CDM","code_information":[{"code":"Px00098110342","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 33210 INSERTION OF HEART ELECTRODE CDM","code_information":[{"code":"Px00098110346","type":"CDM"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":303.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36000 PLACE NEEDLE IN VEIN CDM","code_information":[{"code":"Px00098110348","type":"CDM"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"},{"gross_charge":29.0,"discounted_cash":20.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 40650 REPAIR LIP, FULL THICKNESS VERMILION ONLY CDM","code_information":[{"code":"Px00098110349","type":"CDM"},{"code":"40650","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":534.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":862.0,"discounted_cash":603.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 40652 REPAIR LIP, FULL THICKNESS UP TO HALF VERTICAL HEIGHT CDM","code_information":[{"code":"Px00098110350","type":"CDM"},{"code":"40652","type":"HCPCS"}],"standard_charges":[{"gross_charge":1052.0,"discounted_cash":736.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 40800 DRAINAGE OF MOUTH LESION, SIMPLE CDM","code_information":[{"code":"Px00098110352","type":"CDM"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":236.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 40804 REMOVAL FOREIGN BODY MOUTH, SIMPLE CDM","code_information":[{"code":"Px00098110353","type":"CDM"},{"code":"40804","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":238.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 40830 CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/OR LESS CDM","code_information":[{"code":"Px00098110354","type":"CDM"},{"code":"40830","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 40831 REPAIR MOUTH LACERATION >2.5CM CDM","code_information":[{"code":"Px00098110355","type":"CDM"},{"code":"40831","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":403.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 41000 DRAINAGE OF MOUTH LESION, LINGUAL CDM","code_information":[{"code":"Px00098110356","type":"CDM"},{"code":"41000","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 41250 RPR LAC LTE 2.5 CM MOUTH &/ ANT TWO-THIRDS TONGUE CDM","code_information":[{"code":"Px00098110357","type":"CDM"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":441.0,"discounted_cash":308.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 41251 RPR LAC LTE 2.5 CM POSTERIOR ONE-THIRD TONGUE CDM","code_information":[{"code":"Px00098110358","type":"CDM"},{"code":"41251","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":326.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 41252 REPAIR OF LACER OF TONGUE FLOOR OF MOUTH >2.6 C CDM","code_information":[{"code":"Px00098110359","type":"CDM"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":372.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 41800 DRAINAGE OF GUM LESION CDM","code_information":[{"code":"Px00098110360","type":"CDM"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":420.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 42000 DRAINAGE MOUTH ROOF LESION CDM","code_information":[{"code":"Px00098110361","type":"CDM"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":205.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 42180 REPAIR, LACERATION OF PALATE UP TO 2 CM CDM","code_information":[{"code":"Px00098110362","type":"CDM"},{"code":"42180","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":543.0,"discounted_cash":380.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 42182 REPAIR, LACERATION OF PALATE OVER 2 CM OR COMPLEX CDM","code_information":[{"code":"Px00098110363","type":"CDM"},{"code":"42182","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":450.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 42300 DRAINAGE OF SALIVARY GLAND, SIMPLE CDM","code_information":[{"code":"Px00098110364","type":"CDM"},{"code":"42300","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":272.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 42310 DRAINAGE OF SALIVARY GLAND, SUBLINGUAL CDM","code_information":[{"code":"Px00098110365","type":"CDM"},{"code":"42310","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 42700 DRAINAGE OF TONSIL ABSCESS CDM","code_information":[{"code":"Px00098110366","type":"CDM"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":242.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 42809 REMOVE PHARYNX FOREIGN BODY CDM","code_information":[{"code":"Px00098110368","type":"CDM"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":387.0,"discounted_cash":270.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 42960 CONTROL THROAT BLEEDING, SIMPLE CDM","code_information":[{"code":"Px00098110372","type":"CDM"},{"code":"42960","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 42970 CONTROL NOSE/THROAT BLEEDING CDM","code_information":[{"code":"Px00098110373","type":"CDM"},{"code":"42970","type":"HCPCS"}],"standard_charges":[{"gross_charge":1305.0,"discounted_cash":913.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 43753 TX GASTRO INTUB W/ASP CDM","code_information":[{"code":"Px00098110375","type":"CDM"},{"code":"43753","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 45307 PROCTOSIGMOIDOSCOPY FB CDM","code_information":[{"code":"Px00098110379","type":"CDM"},{"code":"45307","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":181.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 46040 INCISION OF RECTAL ABSCESS CDM","code_information":[{"code":"Px00098110381","type":"CDM"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1034.0,"discounted_cash":723.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 46050 INCISION OF ANAL ABSCESS CDM","code_information":[{"code":"Px00098110382","type":"CDM"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":279.0,"discounted_cash":195.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 46083 INCISE EXTERNAL HEMORRHOID CDM","code_information":[{"code":"Px00098110383","type":"CDM"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":306.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 46320 REMOVAL OF HEMORRHOID CLOT CDM","code_information":[{"code":"Px00098110386","type":"CDM"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":193.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":317.0,"discounted_cash":221.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 46600 DIAGNOSTIC ANOSCOPY CDM","code_information":[{"code":"Px00098110387","type":"CDM"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":116.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 46614 ANOSCOPY CONTROL BLEEDING CDM","code_information":[{"code":"Px00098110389","type":"CDM"},{"code":"46614","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":112.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 51102 DRAIN BL W/CATH INSERTION CDM","code_information":[{"code":"Px00098110394","type":"CDM"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":247.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 51700 IRRIGATION OF BLADDER CDM","code_information":[{"code":"Px00098110395","type":"CDM"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 51702 INSERT TEMP BLADDER CATHETER CDM","code_information":[{"code":"Px00098110396","type":"CDM"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 51703 INSERT BLADDER CATHETER COMPLEX CDM","code_information":[{"code":"Px00098110397","type":"CDM"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 54220 IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM CDM","code_information":[{"code":"Px00098110398","type":"CDM"},{"code":"54220","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":228.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 55100 DRAINAGE OF SCROTUM ABSCESS CDM","code_information":[{"code":"Px00098110399","type":"CDM"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 55120 REMOVAL OF SCROTUM LESION CDM","code_information":[{"code":"Px00098110400","type":"CDM"},{"code":"55120","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.0,"discounted_cash":613.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110402","type":"CDM"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":503.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27788 CLOSED TREATMENT OF ANKLE FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110405","type":"CDM"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.0,"discounted_cash":674.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":1107.0,"discounted_cash":774.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 27808 TREATMENT OF ANKLE FRACTURE BIMAL W/O MANIP CDM","code_information":[{"code":"Px00098110406","type":"CDM"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":755.0,"discounted_cash":528.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27810 TREATMENT OF ANKLE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110409","type":"CDM"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.0,"discounted_cash":746.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":1230.0,"discounted_cash":861.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 27816 CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION CDM","code_information":[{"code":"Px00098110410","type":"CDM"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":501.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27818 CLOSED TX OF ANKLE FRACTURE TRIMALL W/MANIP CDM","code_information":[{"code":"Px00098110413","type":"CDM"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1085.0,"discounted_cash":759.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":1250.0,"discounted_cash":875.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 27830 CLOSED TREAT PROX TIB/FIB DISLOC CDM","code_information":[{"code":"Px00098110415","type":"CDM"},{"code":"27830","type":"HCPCS"}],"standard_charges":[{"gross_charge":881.0,"discounted_cash":616.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27840 CLOSED TREATMENT OF ANKLE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110417","type":"CDM"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":653.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27842 CLOSED TREAT ANKLE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110418","type":"CDM"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":1231.0,"discounted_cash":861.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":1413.0,"discounted_cash":989.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 28192 REMOVAL OF FOOT FOREIGN BODY DEEP CDM","code_information":[{"code":"Px00098110419","type":"CDM"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 28193 REMOVAL OF FOOT FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00098110420","type":"CDM"},{"code":"28193","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":643.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 28208 REPAIR OF FOOT TENDON EXTENSOR TENDON CDM","code_information":[{"code":"Px00098110422","type":"CDM"},{"code":"28208","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 28400 TREATMENT OF HEEL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110424","type":"CDM"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":403.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 28405 TREATMENT OF HEEL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110426","type":"CDM"},{"code":"28405","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":599.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 28430 TREATMENT OF TALUS FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110429","type":"CDM"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":368.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 29700 REMOV BIVAL GAUN BOOT/BODY CAST CDM","code_information":[{"code":"Px00098110430","type":"CDM"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 28450 TREAT MIDFOOT FRACTURE EACH W/O MANIPULATION CDM","code_information":[{"code":"Px00098110432","type":"CDM"},{"code":"28450","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 28455 TREAT MIDFOOT FRACTURE EACH W/MANIPULATION CDM","code_information":[{"code":"Px00098110434","type":"CDM"},{"code":"28455","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":411.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 28470 TREAT METATARSAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110436","type":"CDM"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":546.0,"discounted_cash":382.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 28475 CLOSED TREAT METATARSAL FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110438","type":"CDM"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 28490 CLOSED TREAT BIG TOE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110440","type":"CDM"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":222.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":355.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 28495 TREAT BIG TOE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110443","type":"CDM"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":432.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 28510 TREATMENT OF TOE FRACTURE PHALANX CDM","code_information":[{"code":"Px00098110445","type":"CDM"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":339.0,"discounted_cash":237.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 28515 TREATMENT OF TOE FRACTURE PHALANX W/MANIP CDM","code_information":[{"code":"Px00098110448","type":"CDM"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":251.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 28540 CLOSED TREAT TARSAL DISLOCATION CDM","code_information":[{"code":"Px00098110452","type":"CDM"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 28570 TREAT FOOT DISLOCATION CDM","code_information":[{"code":"Px00098110455","type":"CDM"},{"code":"28570","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":242.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 28575 TREAT FOOT DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110456","type":"CDM"},{"code":"28575","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 28660 CLOSED TREAT TOE DISLOCATION CDM","code_information":[{"code":"Px00098110462","type":"CDM"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":253.0,"discounted_cash":177.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 28665 TREAT TOE DISLOCATION W/ANETH CDM","code_information":[{"code":"Px00098110464","type":"CDM"},{"code":"28665","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 29065 LONG ARM CAST APPLICATION CDM","code_information":[{"code":"Px00098110466","type":"CDM"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 29075 APPLICATION CAST ELBOW FINGER SHORT ARM CDM","code_information":[{"code":"Px00098110467","type":"CDM"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 29105 LONG ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00098110468","type":"CDM"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":170.0,"discounted_cash":119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM","code_information":[{"code":"Px00098110469","type":"CDM"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":69.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":113.0,"discounted_cash":79.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 29240 STRAPPING SHOULDER CDM","code_information":[{"code":"Px00098110472","type":"CDM"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 29280 STRAPPING OF HAND OR FINGER CDM","code_information":[{"code":"Px00098110475","type":"CDM"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 29405 SHORT LEG CAST APPLICATION CDM","code_information":[{"code":"Px00098110476","type":"CDM"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":104.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":172.0,"discounted_cash":120.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 29505 APPLICATION LONG LEG SPLINT CDM","code_information":[{"code":"Px00098110479","type":"CDM"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":126.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"},{"gross_charge":140.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM","code_information":[{"code":"Px00098110480","type":"CDM"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"},{"gross_charge":142.0,"discounted_cash":99.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 29580 APPLICATION OF UNABOOT CDM","code_information":[{"code":"Px00098110482","type":"CDM"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":103.0,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 29705 REMOVE OR BIVALVE CAST-FULL ARM OR LEG CDM","code_information":[{"code":"Px00098110483","type":"CDM"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 28190 REMOVAL OF FOOT FOREIGN BODY CDM","code_information":[{"code":"Px00098110485","type":"CDM"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":233.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 29345 APPLICATION/LONG LEG CAST CDM","code_information":[{"code":"Px00098110486","type":"CDM"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":175.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99282 VISIT STRAIGHTFORWARD MDM CDM","code_information":[{"code":"Px00098110489","type":"CDM"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36556 INSERT NON-TUNNEL CV CATH > 5 CDM","code_information":[{"code":"Px00098110494","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":351.0,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"},{"gross_charge":352.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 36569 INSERTION PICC W/O IMG GDN 5 YR/> CDM","code_information":[{"code":"Px00098110496","type":"CDM"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36620 INSERTION CATHETER ARTERY CDM","code_information":[{"code":"Px00098110499","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":148.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36625 INSERT CATH ARTERY CUTDOWN CDM","code_information":[{"code":"Px00098110500","type":"CDM"},{"code":"36625","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 13131 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CPLX FRHD CKS SHN CDM","code_information":[{"code":"Px00098110501","type":"CDM"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":555.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 13132 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CPLX FRHD CKS SHN CDM","code_information":[{"code":"Px00098110502","type":"CDM"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":1355.0,"discounted_cash":948.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 13133 REPAIR WOUND/LESION ADD ON 5CM CMPLX FRHD CKS SHN MTH NK CDM","code_information":[{"code":"Px00098110503","type":"CDM"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":309.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 13151 REPAIR OF WND OR LESN 1.1 TO 2.5CM CMPLX EYLD NS ERS LPS CDM","code_information":[{"code":"Px00098110505","type":"CDM"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.0,"discounted_cash":639.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 13152 REPAIR OF WND OR LES 2.6 TO 7.5CM CMPLX EYLD NS ERS LPS CDM","code_information":[{"code":"Px00098110506","type":"CDM"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":834.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 16000 INITIAL TREATMENT OF BURN(S) 1ST DEG LOCAL TX CDM","code_information":[{"code":"Px00098110509","type":"CDM"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL CDM","code_information":[{"code":"Px00098110510","type":"CDM"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 16025 DRESS/DEBRID P-THICK BURN M 5-10% TBSA CDM","code_information":[{"code":"Px00098110511","type":"CDM"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 16030 DRESS/DEBRID P-THICK BURN L >10% TBSA CDM","code_information":[{"code":"Px00098110512","type":"CDM"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20100 EXPLORE WOUND NECK CDM","code_information":[{"code":"Px00098110517","type":"CDM"},{"code":"20100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1476.0,"discounted_cash":1033.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20101 EXPLORE WOUND CHEST CDM","code_information":[{"code":"Px00098110518","type":"CDM"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.0,"discounted_cash":810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20102 EXPLORE WOUND ABDOMEN CDM","code_information":[{"code":"Px00098110519","type":"CDM"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1243.0,"discounted_cash":870.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20103 EXPLORE WOUND EXTREMITY CDM","code_information":[{"code":"Px00098110520","type":"CDM"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":1012.0,"discounted_cash":708.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20520 REMOVAL OF FOREIGN BODY MUSC, SIMP CDM","code_information":[{"code":"Px00098110521","type":"CDM"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":293.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20525 REMOVAL OF FOREIGN BODY COMPLEX CDM","code_information":[{"code":"Px00098110522","type":"CDM"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20550 INJ TENDON SHEATH/LIGAMENT CDM","code_information":[{"code":"Px00098110523","type":"CDM"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20552 INJ TRIGGER POINT 1/2 MUSCL CDM","code_information":[{"code":"Px00098110525","type":"CDM"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES CD","code_information":[{"code":"Px00098110526","type":"CDM"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE CDM","code_information":[{"code":"Px00098110528","type":"CDM"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE CDM","code_information":[{"code":"Px00098110529","type":"CDM"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM","code_information":[{"code":"Px00098110530","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":458.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR CDM","code_information":[{"code":"Px00098110531","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 21315 TREATMENT OF NOSE FRACTURE W/O STABILIZATION CDM","code_information":[{"code":"Px00098110534","type":"CDM"},{"code":"21315","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":312.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 21450 TREAT LOWER JAW FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110540","type":"CDM"},{"code":"21450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1572.0,"discounted_cash":1100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 21480 RESET DISLOCATED JAW UNCOMPLICATED CDM","code_information":[{"code":"Px00098110541","type":"CDM"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 21820 TREAT STERNUM FRACTURE CDM","code_information":[{"code":"Px00098110544","type":"CDM"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 22310 TREAT SPINE FRACTURE CDM","code_information":[{"code":"Px00098110547","type":"CDM"},{"code":"22310","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.0,"discounted_cash":532.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23500 TREAT CLAVICLE FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110551","type":"CDM"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":438.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23505 TREAT CLAVICLE FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110553","type":"CDM"},{"code":"23505","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23540 TREAT CLAVICLE DISLOCATIONAC JT DISLO W/O MAN CDM","code_information":[{"code":"Px00098110558","type":"CDM"},{"code":"23540","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23545 TREAT CLAVICLE DISLOCATION AC JT DISLO W/MAN CDM","code_information":[{"code":"Px00098110559","type":"CDM"},{"code":"23545","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":610.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23600 TREAT HUMERUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110563","type":"CDM"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":574.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23605 TREAT HUMERUS FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110564","type":"CDM"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1159.0,"discounted_cash":811.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23620 TREAT HUMERUS FRACTURE TUBEROSITY W/O MAN CDM","code_information":[{"code":"Px00098110566","type":"CDM"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":473.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23625 TREAT HUMERUS FRACTURE TUBEROSITY W/MAN CDM","code_information":[{"code":"Px00098110568","type":"CDM"},{"code":"23625","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.0,"discounted_cash":664.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23650 TREAT SHOULDER DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00098110570","type":"CDM"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.0,"discounted_cash":561.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23655 TREAT SHOULDER DISLOCATION W/MANIP & ANNES CDM","code_information":[{"code":"Px00098110572","type":"CDM"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":787.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23665 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ CDM","code_information":[{"code":"Px00098110574","type":"CDM"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":1122.0,"discounted_cash":785.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 23931 DRAINAGE OF ARM BURSA CDM","code_information":[{"code":"Px00098110578","type":"CDM"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":504.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12056 INTMD WND REPAIR FACE/MM 20.1 TO 30.0CM CDM","code_information":[{"code":"Px00098110579","type":"CDM"},{"code":"12056","type":"HCPCS"}],"standard_charges":[{"gross_charge":1366.0,"discounted_cash":956.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 11732 AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL CDM","code_information":[{"code":"Px00098110581","type":"CDM"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":60.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 21400 TREAT EYE SOCKET FRACTURE NON BLOWOUT W/O MANIPULATION CDM","code_information":[{"code":"Px00098110583","type":"CDM"},{"code":"21400","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36600 WITHDRAWAL OF ARTERIAL BLOOD CDM","code_information":[{"code":"Px00098110587","type":"CDM"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"},{"gross_charge":44.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 36400 VNPNXR/YOUNGER THAN 3YRS PHY/QHP SKILL FEM/JUGLAR VEIN CDM","code_information":[{"code":"Px00098110589","type":"CDM"},{"code":"36400","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36405 VNPNXR/YOUNGER THAN 3 YRS PHYS/QHP SKILL SCALP VEIN CDM","code_information":[{"code":"Px00098110590","type":"CDM"},{"code":"36405","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36406 VNPNXR/YOUNGER THAN 3 YRS PHYS/QHP SKILL OTHER VEIN CDM","code_information":[{"code":"Px00098110591","type":"CDM"},{"code":"36406","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36410 NON-ROUTINE BL DRAW > 3 YRS CDM","code_information":[{"code":"Px00098110592","type":"CDM"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":54.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"},{"gross_charge":28.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 36420 VENIPUNCTURE CUTDOWN YOUNGER THAN 1 YR CDM","code_information":[{"code":"Px00098110593","type":"CDM"},{"code":"36420","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36425 VEIN ACCESS CUTDOWN > 1 YR CDM","code_information":[{"code":"Px00098110594","type":"CDM"},{"code":"36425","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":68.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 92950 CARDIOPULMONARY RESUSCITATION CDM","code_information":[{"code":"Px00098110596","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":368.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 59300 EPISIOTOMY OR VAGINAL REPAIR CDM","code_information":[{"code":"Px00098110601","type":"CDM"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":261.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 59409 VAGINAL DELIVERY CDM","code_information":[{"code":"Px00098110602","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":2044.0,"discounted_cash":1430.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 59414 DELIVER PLACENTA CDM","code_information":[{"code":"Px00098110603","type":"CDM"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 99281 VISIT MINOR PROBLEM MAY NOT REQ PHYS/QHP CDM","code_information":[{"code":"Px00098110604","type":"CDM"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36660 IV CATH UMBILICAL CDM","code_information":[{"code":"Px00098110607","type":"CDM"},{"code":"36660","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":126.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 92977 DISSOLVE CLOT HEART VESSEL IV CDM","code_information":[{"code":"Px00098110612","type":"CDM"},{"code":"92977","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":97.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 36568 INSERTION PICC W/O IMG GUIDANCE/YOUNGER THAN 5 YRS CDM","code_information":[{"code":"Px00098110614","type":"CDM"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":165.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 12051 INTMD WND REPAIR FACE/UP TO 2.5CM CDM","code_information":[{"code":"Px00098110616","type":"CDM"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24620 CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANI CDM","code_information":[{"code":"Px00098110620","type":"CDM"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.0,"discounted_cash":959.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25248 REMOVE FOREARM FOREIGN BODY -FOREARM WRST CDM","code_information":[{"code":"Px00098110621","type":"CDM"},{"code":"25248","type":"HCPCS"}],"standard_charges":[{"gross_charge":1216.0,"discounted_cash":851.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 29550 STRAPPING OF TOES CDM","code_information":[{"code":"Px00098110625","type":"CDM"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":57.0,"discounted_cash":39.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 32501 DRAIN SHOULDER LESION CDM","code_information":[{"code":"Px00098110632","type":"CDM"},{"code":"32501","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":423.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":725.0,"discounted_cash":507.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 43227 ESOPHAGOSCOPY CONTROL BLEED CDM","code_information":[{"code":"Px00098110633","type":"CDM"},{"code":"43227","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":431.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 94728 PULM FUNCT TEST OSCILLOMETRY CDM","code_information":[{"code":"Px00098110634","type":"CDM"},{"code":"94728","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM","code_information":[{"code":"Px00098110645","type":"CDM"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR  99498 ADVANCE CARE PLANNING EA ADDL 30 MINS","code_information":[{"code":"Px00098110695","type":"CDM"},{"code":"99498","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR  99497 ADVANCE CARE PLANNING FIRST 30 MINS","code_information":[{"code":"Px00098110696","type":"CDM"},{"code":"99497","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24500 TREAT HUMERUS FX W/O MANIP CDM","code_information":[{"code":"Px00098110701","type":"CDM"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.0,"discounted_cash":627.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24530 TREAT HUMERUS FRACTURE CDM","code_information":[{"code":"Px00098110704","type":"CDM"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24560 TREAT HUMERUS EPICOND FRACTURE CDM","code_information":[{"code":"Px00098110707","type":"CDM"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.0,"discounted_cash":566.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24576 TREAT HUMERUS CONDYLAR FRACTURE CDM","code_information":[{"code":"Px00098110709","type":"CDM"},{"code":"24576","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":598.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24600 TREAT ELBOW DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110713","type":"CDM"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":661.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24605 TREAT ELBOW DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110714","type":"CDM"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1334.0,"discounted_cash":933.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24640 CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MANIP CDM","code_information":[{"code":"Px00098110716","type":"CDM"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24650 TREAT RADIUS FRACTURE CDM","code_information":[{"code":"Px00098110718","type":"CDM"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":459.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24655 CLOSED TX RADIUS HD FRACTURE CDM","code_information":[{"code":"Px00098110720","type":"CDM"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":1096.0,"discounted_cash":767.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24670 TREAT ULNAR FRACTURE CDM","code_information":[{"code":"Px00098110722","type":"CDM"},{"code":"24670","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.0,"discounted_cash":511.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24675 TREAT ULNAR FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110724","type":"CDM"},{"code":"24675","type":"HCPCS"}],"standard_charges":[{"gross_charge":1189.0,"discounted_cash":832.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25260 REPAIR FOREARM TENDON/MUSCLE CDM","code_information":[{"code":"Px00098110726","type":"CDM"},{"code":"25260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1557.0,"discounted_cash":1089.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25270 REPAIR FOREARM TENDON/MUSCLE SINGLE EA TENDON CDM","code_information":[{"code":"Px00098110728","type":"CDM"},{"code":"25270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":847.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 25500 TREAT FRACTUE OF RADIUS W/O MANIPULATION","code_information":[{"code":"Px00098110730","type":"CDM"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25505 TREAT FRACTURE OF RADIUS W/MANIPULATION CDM","code_information":[{"code":"Px00098110732","type":"CDM"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1313.0,"discounted_cash":919.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25530 TREAT FRACTURE OF ULNA CDM","code_information":[{"code":"Px00098110734","type":"CDM"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":460.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25535 TREATMENT OF FRACTURE OF ULNA W/MANIPULATION CDM","code_information":[{"code":"Px00098110736","type":"CDM"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25565 TREAT FRACTURE RADIUS & ULNA W/MANIPULATION CDM","code_information":[{"code":"Px00098110740","type":"CDM"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1349.0,"discounted_cash":944.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O MANIP CDM","code_information":[{"code":"Px00098110742","type":"CDM"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF CDM","code_information":[{"code":"Px00098110744","type":"CDM"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1493.0,"discounted_cash":1045.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25622 TREAT WRIST BONE FRACTURE CDM","code_information":[{"code":"Px00098110746","type":"CDM"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25624 TREAT WRIST BONE FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110748","type":"CDM"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":1187.0,"discounted_cash":830.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25630 TREAT CARPAL BONE FRACTURE W/O MANIP EACH BONE CDM","code_information":[{"code":"Px00098110750","type":"CDM"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":534.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25635 TREAT CARPAL BONE FRACTURE W/MANIPULATOPM EACH BONE CDM","code_information":[{"code":"Px00098110752","type":"CDM"},{"code":"25635","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":793.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25650 TREAT ULNAR STYLOID FRACTURE CDM","code_information":[{"code":"Px00098110754","type":"CDM"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.0,"discounted_cash":562.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 25675 TREAT DISTAL RADIOULNAR DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00098110757","type":"CDM"},{"code":"25675","type":"HCPCS"}],"standard_charges":[{"gross_charge":1106.0,"discounted_cash":774.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26010 DRAINAGE OF FINGER ABSCESS - SMPL CDM","code_information":[{"code":"Px00098110761","type":"CDM"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26011 DRAINAGE OF FINGER ABSCESS COMP CDM","code_information":[{"code":"Px00098110762","type":"CDM"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.0,"discounted_cash":690.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26350 REPAIR FINGER/HAND TENDON CDM","code_information":[{"code":"Px00098110763","type":"CDM"},{"code":"26350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1763.0,"discounted_cash":1234.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26410 REPAIR EXTENSOR TENDON HAND W/OGRAFT CDM","code_information":[{"code":"Px00098110765","type":"CDM"},{"code":"26410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1614.0,"discounted_cash":1129.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26418 REPAIR OF EXTENSOR TENDON FINGER W/O GRAFT CDM","code_information":[{"code":"Px00098110767","type":"CDM"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":1438.0,"discounted_cash":1006.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26600 TREAT METACARPAL FRACTURE SINGLE W/O MANIP CDM","code_information":[{"code":"Px00098110771","type":"CDM"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":543.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26605 TREAT METACARPAL FRACTURE SINGLE W/MANIP CDM","code_information":[{"code":"Px00098110773","type":"CDM"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":582.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26641 TREAT CARPOMETACARPAL DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00098110775","type":"CDM"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":917.0,"discounted_cash":641.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26645 TX CARPOMETACARPAL FRACTURE/DISLOCATION W/MANIP CDM","code_information":[{"code":"Px00098110777","type":"CDM"},{"code":"26645","type":"HCPCS"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":742.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26670 CLTX CARPO/METACARPL DISLC NOT THMB MANJ EA W/O ANES CDM","code_information":[{"code":"Px00098110779","type":"CDM"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":854.0,"discounted_cash":597.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26700 TREAT KNUCKLE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110781","type":"CDM"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.0,"discounted_cash":594.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26705 TREAT KNUCKLE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110782","type":"CDM"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":951.0,"discounted_cash":665.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26720 CLOSED TX PHALANGEAL SHAFT FRACTURE FING OR THMB W/O MA CDM","code_information":[{"code":"Px00098110783","type":"CDM"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":349.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26725 CLOSED TX PHALANGEAL SHAFT FRACTURE FING OR THMB W/MANI CDM","code_information":[{"code":"Px00098110786","type":"CDM"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.0,"discounted_cash":607.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26740 CLOSED TX ARTICULAR FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110788","type":"CDM"},{"code":"26740","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":400.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26742 CLOSED TX ARTICULAR FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110790","type":"CDM"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":954.0,"discounted_cash":667.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26750 CLOSED TX DISTAL PHALANGEAL FRACTURE FING/THMB W/O MANI CDM","code_information":[{"code":"Px00098110792","type":"CDM"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.0,"discounted_cash":363.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26755 CLOSED TX DISTAL PHALANGEAL FRACTURE FING/THMB W/MANIP CDM","code_information":[{"code":"Px00098110794","type":"CDM"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":787.0,"discounted_cash":550.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26765 OPEN TX DISTAL PHALANGEAL FRACTURE FINGER/THUMB EA CDM","code_information":[{"code":"Px00098110795","type":"CDM"},{"code":"26765","type":"HCPCS"}],"standard_charges":[{"gross_charge":1419.0,"discounted_cash":993.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26770 CLOSED TX FINGER DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110798","type":"CDM"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":500.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 26775 CLOSED TX FINGER DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110800","type":"CDM"},{"code":"26775","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.0,"discounted_cash":672.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 56405 I & D OF VULVA/PERINEUM CDM","code_information":[{"code":"Px00098110802","type":"CDM"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 56420 DRAINAGE OF GLAND ABSCESS CDM","code_information":[{"code":"Px00098110803","type":"CDM"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":160.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":267.0,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 57180 TREAT VAGINAL BLEEDING CDM","code_information":[{"code":"Px00098110806","type":"CDM"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":184.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 57510 CAUTERIZATION OF CERVIX CDM","code_information":[{"code":"Px00098110807","type":"CDM"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 58301 REMOVE INTRAUTERINE DEVICE CDM","code_information":[{"code":"Px00098110808","type":"CDM"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 62270 SPINAL FLUID TAP DIAGNOSTIC CDM","code_information":[{"code":"Px00098110812","type":"CDM"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":135.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"},{"gross_charge":225.0,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 62272 DRAIN CEREBRO SPINAL FLUID CDM","code_information":[{"code":"Px00098110813","type":"CDM"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":245.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 64400 NERVE BLOCK INJ TRIGEMINAL CDM","code_information":[{"code":"Px00098110814","type":"CDM"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 64421 INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL CDM","code_information":[{"code":"Px00098110816","type":"CDM"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 64450 NERVE BLOCK OTHER PERIPHERAL CDM","code_information":[{"code":"Px00098110817","type":"CDM"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 65205 REMOVE FOREIGN BODY FROM EYE SUPERFICIAL CDM","code_information":[{"code":"Px00098110818","type":"CDM"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":77.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":125.0,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 65210 REMOVE FOREIGN BODY FROM EYE EMBEDDED CDM","code_information":[{"code":"Px00098110819","type":"CDM"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 65220 REMOVE FOREIGN BODY FROM EYE CORNEAL W/O SLIT LAMP CDM","code_information":[{"code":"Px00098110820","type":"CDM"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":122.0,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 65222 REMOVE FOREIGN BODY FROM EYE CORNEAL W/ SLIT LAMP CDM","code_information":[{"code":"Px00098110821","type":"CDM"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":93.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":167.0,"discounted_cash":116.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 65600 REVISION OF CORNEA CDM","code_information":[{"code":"Px00098110824","type":"CDM"},{"code":"65600","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":611.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 67700 DRAINAGE OF EYELID ABSCESS CDM","code_information":[{"code":"Px00098110825","type":"CDM"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":207.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 67938 REMOVE EYELID FOREIGN BODY CDM","code_information":[{"code":"Px00098110826","type":"CDM"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 69000 DRAIN EXTERNAL EAR LESION SIMPLE CDM","code_information":[{"code":"Px00098110827","type":"CDM"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":212.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":349.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 69005 DRAIN EXTERNAL EAR LESION COMPLICATED CDM","code_information":[{"code":"Px00098110828","type":"CDM"},{"code":"69005","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 69020 DRAIN OUTER EAR CANAL LESION CDM","code_information":[{"code":"Px00098110829","type":"CDM"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 69200 CLEAR OUTER EAR CANAL W/O GENERAL ANESTHESIA CDM","code_information":[{"code":"Px00098110830","type":"CDM"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":168.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM","code_information":[{"code":"Px00098110831","type":"CDM"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":94.0,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 64420 NERVE BLOCK INJ INTERCOSTA SINGLE CDM","code_information":[{"code":"Px00098110833","type":"CDM"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":196.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 26951 AMPUTATE FINGER/THUMB SINGLE W/DIRECT CLOSURE CDM","code_information":[{"code":"Px00098110835","type":"CDM"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":1613.0,"discounted_cash":1129.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27200 TREAT TAIL BONE FRACTURE CDM","code_information":[{"code":"Px00098110839","type":"CDM"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27220 TREAT HIP SOCKET FRACTURE CDM","code_information":[{"code":"Px00098110841","type":"CDM"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1313.0,"discounted_cash":919.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27230 TX THIGH FRACTURE PROX END NECK W/O MANIP CDM","code_information":[{"code":"Px00098110844","type":"CDM"},{"code":"27230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":826.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27238 CLD TX INTER/PERI/OR SUB-TROCHANTERIC THIGH FX W/O MANIP CDM","code_information":[{"code":"Px00098110845","type":"CDM"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":801.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27246 CLOSED TX GREATER TROCHANTERIC FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110848","type":"CDM"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":953.0,"discounted_cash":667.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27250 CLOSED TX HIP DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110850","type":"CDM"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":312.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27252 CLOSED TX HIP DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110851","type":"CDM"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":2175.0,"discounted_cash":1522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27265 TX POST HIP ARTHROPLASTY DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110854","type":"CDM"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1141.0,"discounted_cash":798.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27266 TX POST HIP ARTHROPLASTY DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110855","type":"CDM"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":1662.0,"discounted_cash":1163.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27301 DRAIN THIGH/KNEE LESION CDM","code_information":[{"code":"Px00098110864","type":"CDM"},{"code":"27301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1685.0,"discounted_cash":1179.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27372 REMOVAL OF FOREIGN BODY DEEP CDM","code_information":[{"code":"Px00098110865","type":"CDM"},{"code":"27372","type":"HCPCS"}],"standard_charges":[{"gross_charge":1528.0,"discounted_cash":1069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27500 CLOSED TREAT FEMORAL SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110866","type":"CDM"},{"code":"27500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1281.0,"discounted_cash":896.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27502 CL TX OF FEMORAL SHAFT FX W/MANIP CDM","code_information":[{"code":"Px00098110869","type":"CDM"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":2593.0,"discounted_cash":1815.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27508 TREAT FEMORAL FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110871","type":"CDM"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":1309.0,"discounted_cash":916.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27510 CLOSED TREATMENT OF DISTAL END FEMOR FRACTURE CDM","code_information":[{"code":"Px00098110872","type":"CDM"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1709.0,"discounted_cash":1196.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27520 CLOSED TX PATELLAR FRACTURE W/O MANIPULATION CDM","code_information":[{"code":"Px00098110873","type":"CDM"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":569.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27550 TREAT KNEE DISLOCATION CDM","code_information":[{"code":"Px00098110878","type":"CDM"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1243.0,"discounted_cash":870.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27552 CLOSED TREAT KNEE DISLOCATION W/ANESTH CDM","code_information":[{"code":"Px00098110879","type":"CDM"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1790.0,"discounted_cash":1253.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27560 CLOSED TREAT KNEE DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110881","type":"CDM"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":695.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27562 CLOSED TREAT PATELLA DISLOCATION W/ANSETH CDM","code_information":[{"code":"Px00098110882","type":"CDM"},{"code":"27562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":837.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":1367.0,"discounted_cash":956.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 27750 CLOSED TREAT TIB SHAFT FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110888","type":"CDM"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.0,"discounted_cash":556.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27752 CLOSED TREAT TIBIAL FRACTURE W/MANIPULATION CDM","code_information":[{"code":"Px00098110890","type":"CDM"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1232.0,"discounted_cash":862.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":1423.0,"discounted_cash":996.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 27760 CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/O MANIP CDM","code_information":[{"code":"Px00098110892","type":"CDM"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.0,"discounted_cash":535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27762 CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/MANIP CDM","code_information":[{"code":"Px00098110895","type":"CDM"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1083.0,"discounted_cash":758.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":1259.0,"discounted_cash":881.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 27780 CLOSED TX OF FIBULA FRACTURE PROX W/O MANIP CDM","code_information":[{"code":"Px00098110898","type":"CDM"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.0,"discounted_cash":490.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 27781 CLOSED TX OF FIBULA FRACTURE PROX W/MANIP CDM","code_information":[{"code":"Px00098110900","type":"CDM"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.0,"discounted_cash":994.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 28600 TREAT FOOT DISLOCATION W/O ANESTH CDM","code_information":[{"code":"Px00098110905","type":"CDM"},{"code":"28600","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 29130 APLICATION OF FINGER SPLINT STATIC CDM","code_information":[{"code":"Px00098110906","type":"CDM"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":82.0,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 49082 ABD PARACENT W/O IMAG GUID CDM","code_information":[{"code":"Px00098110907","type":"CDM"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":123.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":201.0,"discounted_cash":140.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 49083 ABD PARACENT W/IMAG GUIDANCE CDM","code_information":[{"code":"Px00098110908","type":"CDM"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":191.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":309.0,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR ED 1073M ACTIVITY PRESCRIPTION FORM INSURER REQ CDM","code_information":[{"code":"Px00098110914","type":"CDM"},{"code":"1073M","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":52.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 32556 INSERT CATH PLEURA W/O IMAG GD CDM","code_information":[{"code":"Px00098110929","type":"CDM"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":346.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 32555 THORACENTESIS/ASPIR W IMG GD CDM","code_information":[{"code":"Px00098110930","type":"CDM"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 32554 THORACENTESIS/ASPIR W/O IMG GD CDM","code_information":[{"code":"Px00098110931","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 24565 ER CLOSED TX HUMERAL EPICOND FX ME/LA W/ CDM","code_information":[{"code":"Px00098110934","type":"CDM"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1080.0,"discounted_cash":756.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 20610 DRAIN/INJ JOINT/BURSA W/O US CDM","code_information":[{"code":"Px00098110948","type":"CDM"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR ED 97598 DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM CDM","code_information":[{"code":"Px00098110963","type":"CDM"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 64430 NERVE BLOCK INJ PUDENDAL","code_information":[{"code":"Px00098210111","type":"CDM"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":166.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99202 NEW PT VISIT - LEVEL 2","code_information":[{"code":"Px00098310002","type":"CDM"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":127.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99203 NEW PT VISIT - LEVEL 3","code_information":[{"code":"Px00098310003","type":"CDM"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99204 NEW PT VISIT - LEVEL 4","code_information":[{"code":"Px00098310004","type":"CDM"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.0,"discounted_cash":282.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99205 NEW PT VISIT - LEVEL 5","code_information":[{"code":"Px00098310005","type":"CDM"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99211 ESTAB PT VISIT - LEVEL 1","code_information":[{"code":"Px00098310006","type":"CDM"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99212 ESTAB PT VISIT - LEVEL 2","code_information":[{"code":"Px00098310007","type":"CDM"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":74.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99213 ESTAB PT VISIT - LEVEL 3","code_information":[{"code":"Px00098310008","type":"CDM"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":143.0,"discounted_cash":100.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR 99214 ESTAB PT VISIT - LEVEL 4","code_information":[{"code":"Px00098310009","type":"CDM"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":219.0,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR 99215 ESTAB PT VISIT - LEVEL 5","code_information":[{"code":"Px00098310010","type":"CDM"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 51701 INSERT BLADDER CATHETER","code_information":[{"code":"Px00098310440","type":"CDM"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":46.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ EMERGENCY PHYSICIANS (37570101)"},{"gross_charge":72.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ SURGERY CLINIC (37570780)"}]},{"description":"HC PR 93010 ECG 12 LEAD INTERP & REPT ONLY","code_information":[{"code":"Px00098510001","type":"CDM"},{"code":"93010","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 93315 ECHO TEE CONG PROBE IMAGE & REPT","code_information":[{"code":"Px00098510104","type":"CDM"},{"code":"93315","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR G0316 PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN - MEDICARE","code_information":[{"code":"Px00098700005","type":"CDM"},{"code":"G0316","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99221 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES CDM","code_information":[{"code":"Px00098710005","type":"CDM"},{"code":"99221","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":169.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99222 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES CDM","code_information":[{"code":"Px00098710006","type":"CDM"},{"code":"99222","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99223 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES CDM","code_information":[{"code":"Px00098710007","type":"CDM"},{"code":"99223","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":304.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99231 SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES CDM","code_information":[{"code":"Px00098710011","type":"CDM"},{"code":"99231","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":65.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99232 SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES CDM","code_information":[{"code":"Px00098710012","type":"CDM"},{"code":"99232","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99233 SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES CDM","code_information":[{"code":"Px00098710013","type":"CDM"},{"code":"99233","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":172.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99238 HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MINS/OR LESS CDM","code_information":[{"code":"Px00098710017","type":"CDM"},{"code":"99238","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99239 HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN CDM","code_information":[{"code":"Px00098710018","type":"CDM"},{"code":"99239","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99234 HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN CDM","code_information":[{"code":"Px00098710024","type":"CDM"},{"code":"99234","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":263.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99235 HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN CDM","code_information":[{"code":"Px00098710025","type":"CDM"},{"code":"99235","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":331.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"HC PR 99236 HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN CDM","code_information":[{"code":"Px00098710026","type":"CDM"},{"code":"99236","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":426.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION (Unit Price)"}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE EXTERNAL SOLN,LIDOCAINE-EPINEPHRINE-TETRACAINE EXTERNAL SOLN 4-0.05-0.5%,LIDOCAINE-RACEPINEPHRINE-TETRACAINE EXTERNAL SOL 4-0.05-0.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000000120","type":"CDM"},{"code":"00000000120","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 100 MG/ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 2 GM/20ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 1 GM/10ML,CEFAZOLIN SODIUM INJ SOLN PREF SYRINGE 3 GM/30ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000304","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000000304","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 100 MG/ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 2 GM/20ML,CEFAZOLIN SODIUM IV SOLN PREF SYRINGE 1 GM/10ML,CEFAZOLIN SODIUM INJ SOLN PREF SYRINGE 3 GM/30ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000305","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000000305","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFOXITIN 100 MG/ML IV SYRINGE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000310","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"00000000310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN 5 MG/ML IV SYRINGE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000323","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00000000323","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ 10 MG/ML,MORPHINE SULFATE INJ 5 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 10 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 8 MG/ML,MORPHINE SULFATE IV SOLN PF 8 MG/ML,MORPHINE SULFATE-NACL PF SOL PREF SYR 0.5 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 1 MG/ML-0.9%,MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE INJ PF 5 MG/ML,MORPHINE SULFATE INJ PF 8 MG/ML,MORPHINE SULFATE INJ PF 10 MG/ML,MORPHINE SULFATE INJ 1 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 4 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 8 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML,MORPHINE SULFATE IV SOLN 0.5 MG/ML,MORPHINE SULFATE IV SOLN 10 MG/ML,MORPHINE SULFATE-NACL INJ SOLN PREF SYR 2 MG/2ML-0.9%,MORPHINE SULFATE IV SOLN 2 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000338","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00000000338","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML,MEPERIDINE HCL INJ 50 MG/ML,MEPERIDINE HCL INJ 100 MG/ML,MEPERIDINE HCL INJ 75 MG/ML,MEPERIDINE HCL INJ 25 MG/0.5ML (50 MG/ML),MEPERIDINE HCL INJ 100 MG/2ML (50 MG/ML)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000339","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00000000339","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML,LORAZEPAM INJ 4 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000000340","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00000000340","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE 150 MG IN 100 ML D5W IVPB ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000000409","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00000000409","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00000000413","type":"CDM"},{"code":"00000000413","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000442","type":"CDM"},{"code":"00000000442","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISOLONE SOLN 15 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000444","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00000000444","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000000445","type":"CDM"},{"code":"00000000445","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE 100 MCG/ML PCA SYRINGE","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000000457","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00000000457","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROMETHAZINE HCL ORAL SOLN 6.25 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000464","type":"CDM"},{"code":"Q0169","type":"HCPCS"},{"code":"00000000464","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE ORAL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000655","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00000000655","type":"NDC"}],"standard_charges":[{"gross_charge":11.73,"discounted_cash":8.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE 10 MG/ML PO SOLN (FROM INJ)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000000681","type":"CDM"},{"code":"00000000681","type":"NDC"}],"standard_charges":[{"gross_charge":20.23,"discounted_cash":14.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000000901","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"00000000901","type":"NDC"}],"standard_charges":[{"gross_charge":46.88,"discounted_cash":32.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML (22.5 ML PREPACK)","drug_information":{"unit":22.5,"type":"ML"},"code_information":[{"code":"Rx00000000990","type":"CDM"},{"code":"00000000990","type":"NDC"}],"standard_charges":[{"gross_charge":346.04,"discounted_cash":242.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXEPIN HCL CONC 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001156","type":"CDM"},{"code":"00000001156","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXEPIN HCL CONC 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001157","type":"CDM"},{"code":"00000001157","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00000001401","type":"CDM"},{"code":"00000001401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE 250 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000001407","type":"CDM"},{"code":"00000001407","type":"NDC"}],"standard_charges":[{"gross_charge":51.59,"discounted_cash":36.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000001527","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000001527","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx00000001528","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000001528","type":"NDC"}],"standard_charges":[{"gross_charge":127.2,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00000001529","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000001529","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000001538","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000001538","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000001539","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000001539","type":"NDC"}],"standard_charges":[{"gross_charge":172.35,"discounted_cash":120.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000001567","type":"CDM"},{"code":"00000001567","type":"NDC"}],"standard_charges":[{"gross_charge":12.09,"discounted_cash":8.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PB-HYOSCY-ATROP-SCOPOL ELIX 16.2-0.1037-0.0194-0.0065 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001572","type":"CDM"},{"code":"00000001572","type":"NDC"}],"standard_charges":[{"gross_charge":11.51,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000001580","type":"CDM"},{"code":"00000001580","type":"NDC"}],"standard_charges":[{"gross_charge":83.61,"discounted_cash":58.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 (ED HOMEPACK) OTIC SUSP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000001593","type":"CDM"},{"code":"00000001593","type":"NDC"}],"standard_charges":[{"gross_charge":97.89,"discounted_cash":68.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":4.0,"type":"EA"},"code_information":[{"code":"Rx00000001594","type":"CDM"},{"code":"00000001594","type":"NDC"}],"standard_charges":[{"gross_charge":61.98,"discounted_cash":43.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE EXTERNAL SOLN,LIDOCAINE-EPINEPHRINE-TETRACAINE EXTERNAL SOLN 4-0.05-0.5%,LIDOCAINE-RACEPINEPHRINE-TETRACAINE EXTERNAL SOL 4-0.05-0.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00000001749","type":"CDM"},{"code":"00000001749","type":"NDC"}],"standard_charges":[{"gross_charge":418.75,"discounted_cash":293.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERYTHROMYCIN 5 MG/GM (ED HOMEPACK) OP OINT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00000001796","type":"CDM"},{"code":"00000001796","type":"NDC"}],"standard_charges":[{"gross_charge":66.35,"discounted_cash":46.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE-NACL IV SOLUTION 50 MG/250ML-0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000001828","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00000001828","type":"NDC"}],"standard_charges":[{"gross_charge":184.38,"discounted_cash":129.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE 0.05% INJECTION (ANESTHESIA MIX)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001871","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001871","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL-NACL INJ SOLN PREF SYR 0.0625-0.9% (50 ML)","drug_information":{"unit":5.6,"type":"ML"},"code_information":[{"code":"Rx00000001872","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001872","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE 0.075% INJECTION (ANESTHESIA MIX)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001873","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001873","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE 0.1% INJECTION (ANESTHESIA MIX)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000001874","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001874","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE 0.125% INJECTION (ANESTHESIA MIX)","drug_information":{"unit":5.2,"type":"ML"},"code_information":[{"code":"Rx00000001875","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00000001875","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000002061","type":"CDM"},{"code":"00000002061","type":"NDC"}],"standard_charges":[{"gross_charge":54.51,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000002130","type":"CDM"},{"code":"00000002130","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | NDC EA = 1 TABLET"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000002213","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"00000002213","type":"NDC"}],"standard_charges":[{"gross_charge":111.14,"discounted_cash":77.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL CIT 0.4 MG/200ML-ROPIV 0.1%-NACL 0.9% EPIDURAL INJ,FENTANYL 0.2 MG/100ML-ROPIV 0.1%-NACL 0.9% EPIDURAL INJ,FENTANYL CIT 0.1 MG/50ML-ROPIV 0.1%-NACL 0.9% SOL PREF SYR,FENTANYL 0.5 MG/250ML-ROPIV 0.1%-NACL 0.9% EPIDURAL INJ","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00000002665","type":"CDM"},{"code":"00000002665","type":"NDC"}],"standard_charges":[{"gross_charge":754.21,"discounted_cash":527.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000002728","type":"CDM"},{"code":"00000002728","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 5 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 150 MG/30ML-0.9%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00000002856","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00000002856","type":"NDC"}],"standard_charges":[{"gross_charge":150.44,"discounted_cash":105.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003035","type":"CDM"},{"code":"00000003035","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN 400 MG/5ML (ED PREPACK-OR) PO SUSR","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003060","type":"CDM"},{"code":"00000003060","type":"NDC"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NOREPINEPHRINE-DEXTROSE IV SOLUTION 4 MG/250ML-5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000003246","type":"CDM"},{"code":"00000003246","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx00000003291","type":"CDM"},{"code":"00000003291","type":"NDC"}],"standard_charges":[{"gross_charge":14.04,"discounted_cash":9.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL INJ 2 MG/ML,HYDROMORPHONE HCL INJ 4 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.5 MG/ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 2 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 2 MG/ML,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 4 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.2 MG/0.2ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.5 MG/0.5ML-0.9%,HYDROMORPHONE HCL INJ 0.5 MG/ML,HYDROMORPHONE HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000003352","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00000003352","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCOD POLST-CHLORPHEN POLST ER SUSP 10-8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000003401","type":"CDM"},{"code":"00000003401","type":"NDC"}],"standard_charges":[{"gross_charge":15.34,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000003439","type":"CDM"},{"code":"00000003439","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOBUTAMINE 1000 MG IN 250 ML NS INFUSION ONE STEP","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00000003505","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00000003505","type":"NDC"}],"standard_charges":[{"gross_charge":189.48,"discounted_cash":132.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL CONC 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000003663","type":"CDM"},{"code":"00000003663","type":"NDC"}],"standard_charges":[{"gross_charge":12.7,"discounted_cash":8.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000003703","type":"CDM"},{"code":"00000003703","type":"NDC"}],"standard_charges":[{"gross_charge":11.11,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE 1% WITH EPINEPHRINE 1:20000 - ONE STEP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000003720","type":"CDM"},{"code":"00000003720","type":"NDC"}],"standard_charges":[{"gross_charge":262.35,"discounted_cash":183.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD MINIBAG SIMPLE 2.25 GM (2-0.25 GM)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000003898","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000003898","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004000","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004000","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000004001","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004002","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000004002","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000004003","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000004003","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004005","type":"CDM"},{"code":"00000004005","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00000004008","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000004008","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004009","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000004009","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00000004010","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00000004010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00000004011","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00000004011","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00000004012","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00000004012","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004014","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00000004014","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000004015","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00000004015","type":"NDC"}],"standard_charges":[{"gross_charge":159.79,"discounted_cash":111.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004016","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00000004016","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00000004017","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00000004017","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000004018","type":"CDM"},{"code":"00000004018","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00000004019","type":"CDM"},{"code":"00000004019","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ","drug_information":{"unit":2.01481481481481,"type":"ML"},"code_information":[{"code":"Rx00000004020","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000004020","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ","drug_information":{"unit":1.51111111111111,"type":"ML"},"code_information":[{"code":"Rx00000004021","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000004021","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 0.8-0.16 MG/ML IV SOLN (COMPOUND)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004119","type":"CDM"},{"code":"00000004119","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 0.008-0.0016 MG/ML IV SOLN (COMPOUND)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004120","type":"CDM"},{"code":"00000004120","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00000004132","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00000004132","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004133","type":"CDM"},{"code":"00000004133","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004135","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000004135","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00000004136","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000004136","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00000004137","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00000004137","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00000004138","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000004138","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004140","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00000004140","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004164","type":"CDM"},{"code":"00000004164","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004165","type":"CDM"},{"code":"00000004165","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00000004168","type":"CDM"},{"code":"00000004168","type":"NDC"}],"standard_charges":[{"gross_charge":13.86,"discounted_cash":9.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE ORAL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004402","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00000004402","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000004518","type":"CDM"},{"code":"00000004518","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT (ED HOMEPACK) INHAL AERS","drug_information":{"unit":8.0,"type":"GM"},"code_information":[{"code":"Rx00000004540","type":"CDM"},{"code":"00000004540","type":"NDC"}],"standard_charges":[{"gross_charge":94.98,"discounted_cash":66.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004545","type":"CDM"},{"code":"00000004545","type":"NDC"}],"standard_charges":[{"gross_charge":58.97,"discounted_cash":41.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004556","type":"CDM"},{"code":"00000004556","type":"NDC"}],"standard_charges":[{"gross_charge":52.32,"discounted_cash":36.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG (ED HOMEPACK) TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004559","type":"CDM"},{"code":"00000004559","type":"NDC"}],"standard_charges":[{"gross_charge":52.01,"discounted_cash":36.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | NDC EA = 4 TABLET"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA MINIBAG SIMPLE NS 3.375 GM (3-0.375 GM)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004636","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000004636","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD MINIBAG SIMPLE 4.5 GM (4-0.5 GM)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000004637","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00000004637","type":"NDC"}],"standard_charges":[{"gross_charge":226.82,"discounted_cash":158.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROMETHAZINE HCL 25 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004647","type":"CDM"},{"code":"00000004647","type":"NDC"}],"standard_charges":[{"gross_charge":54.22,"discounted_cash":37.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PB-HYOSCY-ATROP-SCOPOL ELIX 16.2-0.1037-0.0194-0.0065 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004659","type":"CDM"},{"code":"00000004659","type":"NDC"}],"standard_charges":[{"gross_charge":27.71,"discounted_cash":19.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VODKA LIQUID","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000004673","type":"CDM"},{"code":"00000004673","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM 0.5 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004678","type":"CDM"},{"code":"00000004678","type":"NDC"}],"standard_charges":[{"gross_charge":51.3,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GENTAMICIN SULFATE 0.3 % (ED HOMEPACK) OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004682","type":"CDM"},{"code":"00000004682","type":"NDC"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 875-125 MG (ED HOMEPACK) TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004690","type":"CDM"},{"code":"00000004690","type":"NDC"}],"standard_charges":[{"gross_charge":51.98,"discounted_cash":36.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL 10 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004693","type":"CDM"},{"code":"00000004693","type":"NDC"}],"standard_charges":[{"gross_charge":51.44,"discounted_cash":36.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG PREPACK","drug_information":{"unit":3.0,"type":"EA"},"code_information":[{"code":"Rx00000004694","type":"CDM"},{"code":"00000004694","type":"NDC"}],"standard_charges":[{"gross_charge":61.63,"discounted_cash":43.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE 10 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":10.0,"type":"EA"},"code_information":[{"code":"Rx00000004704","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00000004704","type":"NDC"}],"standard_charges":[{"gross_charge":53.62,"discounted_cash":37.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE 10 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004726","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00000004726","type":"NDC"}],"standard_charges":[{"gross_charge":52.37,"discounted_cash":36.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":6.0,"type":"EA"},"code_information":[{"code":"Rx00000004794","type":"CDM"},{"code":"00000004794","type":"NDC"}],"standard_charges":[{"gross_charge":52.51,"discounted_cash":36.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOCUSATE SODIUM SYRUP 60 MG/15ML","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx00000004814","type":"CDM"},{"code":"00000004814","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PB-HYOSCY-ATROP-SCOPOL ELIX 16.2-0.1037-0.0194-0.0065 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004815","type":"CDM"},{"code":"00000004815","type":"NDC"}],"standard_charges":[{"gross_charge":23.68,"discounted_cash":16.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000004816","type":"CDM"},{"code":"00000004816","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL ORAL SOLN 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004817","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"00000004817","type":"NDC"}],"standard_charges":[{"gross_charge":24.55,"discounted_cash":17.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROMETHAZINE HCL ORAL SOLN 6.25 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004819","type":"CDM"},{"code":"Q0169","type":"HCPCS"},{"code":"00000004819","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004828","type":"CDM"},{"code":"00000004828","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYD-LIDOCAINE-AL HYDROXIDE-MG HYDROXIDE-SIMETH","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx00000004834","type":"CDM"},{"code":"0000004834","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML (HOMEPACK) PO SUSR","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000004836","type":"CDM"},{"code":"00000004836","type":"NDC"}],"standard_charges":[{"gross_charge":67.48,"discounted_cash":47.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISOLONE SOLN 15 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00000004839","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00000004839","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZOCAINE-MENTHOL LOZENGE 6-10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000004887","type":"CDM"},{"code":"00000004887","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL LACTATE ORAL CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00000004955","type":"CDM"},{"code":"00000004955","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":8.0,"type":"EA"},"code_information":[{"code":"Rx00000004957","type":"CDM"},{"code":"00000004957","type":"NDC"}],"standard_charges":[{"gross_charge":50.83,"discounted_cash":35.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL 5 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005045","type":"CDM"},{"code":"00000005045","type":"NDC"}],"standard_charges":[{"gross_charge":51.36,"discounted_cash":35.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN 250 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000005090","type":"CDM"},{"code":"00000005090","type":"NDC"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":37.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE 0.5% 6 ML AND BETAMETHASONE 2 ML (12 MG) - ONE STEP","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"Rx00000005136","type":"CDM"},{"code":"00000005136","type":"NDC"}],"standard_charges":[{"gross_charge":129.48,"discounted_cash":90.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000005139","type":"CDM"},{"code":"00000005139","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000005140","type":"CDM"},{"code":"00000005140","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00000005141","type":"CDM"},{"code":"00000005141","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFDINIR 125 MG/5ML (ED HOMEPACK) PO SUSR","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00000005483","type":"CDM"},{"code":"00000005483","type":"NDC"}],"standard_charges":[{"gross_charge":70.65,"discounted_cash":49.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000006856","type":"CDM"},{"code":"00000006856","type":"NDC"}],"standard_charges":[{"gross_charge":12.73,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000006857","type":"CDM"},{"code":"00000006857","type":"NDC"}],"standard_charges":[{"gross_charge":15.35,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN FOR ORAL SUSP 500 MG/5ML (10%) (10 GM/100ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00000006858","type":"CDM"},{"code":"00000006858","type":"NDC"}],"standard_charges":[{"gross_charge":12.73,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00000006859","type":"CDM"},{"code":"00000006859","type":"NDC"}],"standard_charges":[{"gross_charge":12.17,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"Rx00000006860","type":"CDM"},{"code":"00000006860","type":"NDC"}],"standard_charges":[{"gross_charge":10.16,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":64.0,"type":"ML"},"code_information":[{"code":"Rx00000006861","type":"CDM"},{"code":"00000006861","type":"NDC"}],"standard_charges":[{"gross_charge":14.66,"discounted_cash":10.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":32.0,"type":"ML"},"code_information":[{"code":"Rx00000006862","type":"CDM"},{"code":"00000006862","type":"NDC"}],"standard_charges":[{"gross_charge":12.39,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML","drug_information":{"unit":31.25,"type":"ML"},"code_information":[{"code":"Rx00000006863","type":"CDM"},{"code":"00000006863","type":"NDC"}],"standard_charges":[{"gross_charge":12.34,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN 1 MG/ML COMPOUNDED ORAL SUSPENSION (DESENSITIZATION PROTOCOL)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00000006951","type":"CDM"},{"code":"00000006951","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EMTRICITABINE-TENOFOVIR DF 200-300 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00000007858","type":"CDM"},{"code":"00000007858","type":"NDC"}],"standard_charges":[{"gross_charge":55.23,"discounted_cash":38.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RALTEGRAVIR POTASSIUM 400 MG (ED HOMEPACK) PO TABS","drug_information":{"unit":60.0,"type":"EA"},"code_information":[{"code":"Rx00000007859","type":"CDM"},{"code":"00000007859","type":"NDC"}],"standard_charges":[{"gross_charge":4704.16,"discounted_cash":3292.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002411230","type":"CDM"},{"code":"00002411230","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BARICITINIB TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00002418230","type":"CDM"},{"code":"00002418230","type":"NDC"}],"standard_charges":[{"gross_charge":165.91,"discounted_cash":116.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002751017","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002751017","type":"NDC"}],"standard_charges":[{"gross_charge":191.96,"discounted_cash":134.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN LISPRO INJ SOLN 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002751017","type":"CDM"},{"code":"J1817","type":"HCPCS"},{"code":"00002751017","type":"NDC"}],"standard_charges":[{"gross_charge":191.96,"discounted_cash":134.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002821501","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002821501","type":"NDC"}],"standard_charges":[{"gross_charge":340.07,"discounted_cash":238.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002822201","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002822201","type":"NDC"}],"standard_charges":[{"gross_charge":758.55,"discounted_cash":530.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002822259","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002822259","type":"NDC"}],"standard_charges":[{"gross_charge":275.47,"discounted_cash":192.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) INJ 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002831517","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002831517","type":"NDC"}],"standard_charges":[{"gross_charge":702.08,"discounted_cash":491.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN ISOPHANE & REGULAR (HUMAN) INJ 100 UNIT/ML (70-30),INSULIN ISOPHANE & REGULAR SUSP PEN-INJ 100 UNIT/ML (70-30)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00002871501","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002871501","type":"NDC"}],"standard_charges":[{"gross_charge":340.07,"discounted_cash":238.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002879901","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002879901","type":"NDC"}],"standard_charges":[{"gross_charge":255.89,"discounted_cash":179.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002879959","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002879959","type":"NDC"}],"standard_charges":[{"gross_charge":275.47,"discounted_cash":192.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN NPH & REGULAR SUSP PEN-INJ 100 UNIT/ML (70-30)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00002880301","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00002880301","type":"NDC"}],"standard_charges":[{"gross_charge":191.4,"discounted_cash":133.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00003029305","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"00003029305","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"APIXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003089331","type":"CDM"},{"code":"00003089331","type":"NDC"}],"standard_charges":[{"gross_charge":12.69,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"APIXABAN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003089421","type":"CDM"},{"code":"00003089421","type":"NDC"}],"standard_charges":[{"gross_charge":12.69,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"APIXABAN TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003089431","type":"CDM"},{"code":"00003089431","type":"NDC"}],"standard_charges":[{"gross_charge":12.69,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ABATACEPT FOR IV SOLN 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003218713","type":"CDM"},{"code":"J0129","type":"HCPCS"},{"code":"00003218713","type":"NDC"}],"standard_charges":[{"gross_charge":5798.49,"discounted_cash":4058.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003256016","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00003256016","type":"NDC"}],"standard_charges":[{"gross_charge":433.35,"discounted_cash":303.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00003257016","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00003257016","type":"NDC"}],"standard_charges":[{"gross_charge":867.07,"discounted_cash":606.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004025901","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00004025901","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004080085","type":"CDM"},{"code":"00004080085","type":"NDC"}],"standard_charges":[{"gross_charge":36.16,"discounted_cash":25.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00004080285","type":"CDM"},{"code":"00004080285","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx00004082205","type":"CDM"},{"code":"00004082205","type":"NDC"}],"standard_charges":[{"gross_charge":64.37,"discounted_cash":45.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00005200002","type":"CDM"},{"code":"90677","type":"HCPCS"},{"code":"00005200002","type":"NDC"}],"standard_charges":[{"gross_charge":868.71,"discounted_cash":608.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00005200010","type":"CDM"},{"code":"90677","type":"HCPCS"},{"code":"00005200010","type":"NDC"}],"standard_charges":[{"gross_charge":868.71,"discounted_cash":608.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RALTEGRAVIR POTASSIUM TAB 400 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006022761","type":"CDM"},{"code":"00006022761","type":"NDC"}],"standard_charges":[{"gross_charge":69.65,"discounted_cash":48.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006384371","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"00006384371","type":"NDC"}],"standard_charges":[{"gross_charge":1536.97,"discounted_cash":1075.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEASLES-MUMPS-RUBELLA VIRUS VACCINES FOR INJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00006468100","type":"CDM"},{"code":"90707","type":"HCPCS"},{"code":"00006468100","type":"NDC"}],"standard_charges":[{"gross_charge":246.65,"discounted_cash":172.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUGAMMADEX SODIUM IV 200 MG/2ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00006542302","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00006542302","type":"NDC"}],"standard_charges":[{"gross_charge":1151.77,"discounted_cash":806.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUGAMMADEX SODIUM IV 200 MG/2ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00006542312","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00006542312","type":"NDC"}],"standard_charges":[{"gross_charge":1613.94,"discounted_cash":1129.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008084181","type":"CDM"},{"code":"00008084181","type":"NDC"}],"standard_charges":[{"gross_charge":34.93,"discounted_cash":24.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008092351","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"00008092351","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008092355","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"00008092355","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00008092360","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"00008092360","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001103","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009001103","type":"NDC"}],"standard_charges":[{"gross_charge":347.25,"discounted_cash":243.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001104","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009001104","type":"NDC"}],"standard_charges":[{"gross_charge":344.28,"discounted_cash":241.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001201","type":"CDM"},{"code":"00009001201","type":"NDC"}],"standard_charges":[{"gross_charge":11.84,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001612","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009001612","type":"NDC"}],"standard_charges":[{"gross_charge":1033.62,"discounted_cash":723.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 1000 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009001820","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009001820","type":"NDC"}],"standard_charges":[{"gross_charge":878.63,"discounted_cash":615.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009003928","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009003928","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009003930","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009003930","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009003932","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009003932","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009003933","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009003933","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009004722","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009004722","type":"NDC"}],"standard_charges":[{"gross_charge":151.84,"discounted_cash":106.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ PF 125 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009004725","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009004725","type":"NDC"}],"standard_charges":[{"gross_charge":117.37,"discounted_cash":82.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00009074630","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"00009074630","type":"NDC"}],"standard_charges":[{"gross_charge":767.33,"discounted_cash":537.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE SOD SUCC FOR INJ 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009075801","type":"CDM"},{"code":"J2919","type":"HCPCS"},{"code":"00009075801","type":"NDC"}],"standard_charges":[{"gross_charge":353.29,"discounted_cash":247.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 300 MG/2ML,CLINDAMYCIN PHOSPHATE INJ 600 MG/4ML,CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML,CLINDAMYCIN PHOSPHATE INJ 9 GM/60ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009077520","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009077520","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 300 MG/2ML,CLINDAMYCIN PHOSPHATE INJ 600 MG/4ML,CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML,CLINDAMYCIN PHOSPHATE INJ 9 GM/60ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00009077526","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00009077526","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00009082501","type":"CDM"},{"code":"J1720","type":"HCPCS"},{"code":"00009082501","type":"NDC"}],"standard_charges":[{"gross_charge":275.54,"discounted_cash":192.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00009085605","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"00009085605","type":"NDC"}],"standard_charges":[{"gross_charge":1911.64,"discounted_cash":1338.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00009085608","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"00009085608","type":"NDC"}],"standard_charges":[{"gross_charge":969.3,"discounted_cash":678.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00009307301","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009307301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00009347501","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009347501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00009347522","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00009347522","type":"NDC"}],"standard_charges":[{"gross_charge":155.02,"discounted_cash":108.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LINEZOLID IV SOLN 200 MG/100ML (2 MG/ML),LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML),LINEZOLID IN SODIUM CHLORIDE IV SOLN 600 MG/300ML-0.9%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00009514001","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"00009514001","type":"NDC"}],"standard_charges":[{"gross_charge":819.33,"discounted_cash":573.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00023031204","type":"CDM"},{"code":"00023031204","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":6.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00023079815","type":"CDM"},{"code":"00023079815","type":"NDC"}],"standard_charges":[{"gross_charge":7.69,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBOXYMETHYLCELLULOSE-GLYCERIN OPHTH GEL 1-0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00023545910","type":"CDM"},{"code":"00023545910","type":"NDC"}],"standard_charges":[{"gross_charge":10.07,"discounted_cash":7.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IRON DEXTRAN INJ 50 MG/ML (ELEMENTAL IRON)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00023608201","type":"CDM"},{"code":"J1750","type":"HCPCS"},{"code":"00023608201","type":"NDC"}],"standard_charges":[{"gross_charge":135.77,"discounted_cash":95.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IRON DEXTRAN INJ 50 MG/ML (ELEMENTAL IRON)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00023608210","type":"CDM"},{"code":"J1750","type":"HCPCS"},{"code":"00023608210","type":"NDC"}],"standard_charges":[{"gross_charge":135.81,"discounted_cash":95.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOSPORINE (OPHTH) EMULSION 0.05%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023916330","type":"CDM"},{"code":"00023916330","type":"NDC"}],"standard_charges":[{"gross_charge":28.56,"discounted_cash":19.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOSPORINE (OPHTH) EMULSION 0.05%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00023916360","type":"CDM"},{"code":"00023916360","type":"NDC"}],"standard_charges":[{"gross_charge":28.56,"discounted_cash":19.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CAMPHOR & PHENOL GEL 10.8-4.7%","drug_information":{"unit":6.5,"type":"GM"},"code_information":[{"code":"Rx00024021201","type":"CDM"},{"code":"00024021201","type":"NDC"}],"standard_charges":[{"gross_charge":3.61,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DRONEDARONE HCL TAB 400 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024414210","type":"CDM"},{"code":"00024414210","type":"NDC"}],"standard_charges":[{"gross_charge":28.76,"discounted_cash":20.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DRONEDARONE HCL TAB 400 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00024414260","type":"CDM"},{"code":"00024414260","type":"NDC"}],"standard_charges":[{"gross_charge":32.8,"discounted_cash":22.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025152034","type":"CDM"},{"code":"00025152034","type":"NDC"}],"standard_charges":[{"gross_charge":25.51,"discounted_cash":17.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CELECOXIB CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025152534","type":"CDM"},{"code":"00025152534","type":"NDC"}],"standard_charges":[{"gross_charge":38.26,"discounted_cash":26.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DISOPYRAMIDE PHOSPHATE CAP ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00025274231","type":"CDM"},{"code":"00025274231","type":"NDC"}],"standard_charges":[{"gross_charge":18.86,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 24000-76000-120000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032122401","type":"CDM"},{"code":"00032122401","type":"NDC"}],"standard_charges":[{"gross_charge":24.24,"discounted_cash":16.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 24000-76000-120000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032122407","type":"CDM"},{"code":"00032122407","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) DR CAP 24000-76000-120000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00032263601","type":"CDM"},{"code":"00032263601","type":"NDC"}],"standard_charges":[{"gross_charge":24.7,"discounted_cash":17.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESTROGENS, CONJUGATED TAB 0.3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046110081","type":"CDM"},{"code":"00046110081","type":"NDC"}],"standard_charges":[{"gross_charge":22.24,"discounted_cash":15.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESTROGENS, CONJUGATED TAB 0.625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00046110281","type":"CDM"},{"code":"00046110281","type":"NDC"}],"standard_charges":[{"gross_charge":22.24,"discounted_cash":15.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049001381","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00049001381","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049001383","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00049001383","type":"NDC"}],"standard_charges":[{"gross_charge":110.4,"discounted_cash":77.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049001481","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00049001481","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049001483","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00049001483","type":"NDC"}],"standard_charges":[{"gross_charge":208.78,"discounted_cash":146.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049052022","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00049052022","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SERTRALINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049491030","type":"CDM"},{"code":"00049491030","type":"NDC"}],"standard_charges":[{"gross_charge":34.9,"discounted_cash":24.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SERTRALINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00049496030","type":"CDM"},{"code":"00049496030","type":"NDC"}],"standard_charges":[{"gross_charge":35.65,"discounted_cash":24.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054000713","type":"CDM"},{"code":"00054000713","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001020","type":"CDM"},{"code":"00054001020","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001021","type":"CDM"},{"code":"00054001021","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001720","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001720","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001820","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001820","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001825","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001825","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054001829","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054001829","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CILOSTAZOL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054002821","type":"CDM"},{"code":"00054002821","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLARITHROMYCIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054003721","type":"CDM"},{"code":"00054003721","type":"NDC"}],"standard_charges":[{"gross_charge":11.83,"discounted_cash":8.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054008826","type":"CDM"},{"code":"00054008826","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GALANTAMINE HYDROBROMIDE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054009021","type":"CDM"},{"code":"00054009021","type":"NDC"}],"standard_charges":[{"gross_charge":11.22,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054017613","type":"CDM"},{"code":"00054017613","type":"NDC"}],"standard_charges":[{"gross_charge":12.24,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054017713","type":"CDM"},{"code":"J0571","type":"HCPCS"},{"code":"00054017713","type":"NDC"}],"standard_charges":[{"gross_charge":13.94,"discounted_cash":9.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054023524","type":"CDM"},{"code":"00054023524","type":"NDC"}],"standard_charges":[{"gross_charge":12.83,"discounted_cash":8.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054023525","type":"CDM"},{"code":"00054023525","type":"NDC"}],"standard_charges":[{"gross_charge":12.11,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CODEINE SULFATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054024424","type":"CDM"},{"code":"00054024424","type":"NDC"}],"standard_charges":[{"gross_charge":13.01,"discounted_cash":9.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054040444","type":"CDM"},{"code":"00054040444","type":"NDC"}],"standard_charges":[{"gross_charge":11.69,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054051741","type":"CDM"},{"code":"00054051741","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054051744","type":"CDM"},{"code":"00054051744","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT","drug_information":{"unit":16.0,"type":"GM"},"code_information":[{"code":"Rx00054327099","type":"CDM"},{"code":"00054327099","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00054350547","type":"CDM"},{"code":"00054350547","type":"NDC"}],"standard_charges":[{"gross_charge":157.62,"discounted_cash":110.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054353201","type":"CDM"},{"code":"00054353201","type":"NDC"}],"standard_charges":[{"gross_charge":11.81,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00054353244","type":"CDM"},{"code":"00054353244","type":"NDC"}],"standard_charges":[{"gross_charge":11.81,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00054356699","type":"CDM"},{"code":"00054356699","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":11.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE ORAL SOLN 5 MG/5ML","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00054372250","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054372250","type":"NDC"}],"standard_charges":[{"gross_charge":138.25,"discounted_cash":96.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054418125","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054418125","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054418425","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054418425","type":"NDC"}],"standard_charges":[{"gross_charge":10.91,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054429925","type":"CDM"},{"code":"00054429925","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOTRIMAZOLE TROCHE 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054814622","type":"CDM"},{"code":"00054814622","type":"NDC"}],"standard_charges":[{"gross_charge":14.83,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054817425","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054817425","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054817525","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"00054817525","type":"NDC"}],"standard_charges":[{"gross_charge":11.92,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054829725","type":"CDM"},{"code":"00054829725","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LITHIUM CARBONATE CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054852725","type":"CDM"},{"code":"00054852725","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054855324","type":"CDM"},{"code":"00054855324","type":"NDC"}],"standard_charges":[{"gross_charge":12.07,"discounted_cash":8.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE ORAL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00054872216","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054872216","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054872425","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054872425","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00054873925","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00054873925","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056016901","type":"CDM"},{"code":"00056016901","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056016975","type":"CDM"},{"code":"00056016975","type":"NDC"}],"standard_charges":[{"gross_charge":13.68,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017201","type":"CDM"},{"code":"00056017201","type":"NDC"}],"standard_charges":[{"gross_charge":14.11,"discounted_cash":9.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017275","type":"CDM"},{"code":"00056017275","type":"NDC"}],"standard_charges":[{"gross_charge":14.11,"discounted_cash":9.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017601","type":"CDM"},{"code":"00056017601","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056017675","type":"CDM"},{"code":"00056017675","type":"NDC"}],"standard_charges":[{"gross_charge":13.95,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056018801","type":"CDM"},{"code":"00056018801","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00056018875","type":"CDM"},{"code":"00056018875","type":"NDC"}],"standard_charges":[{"gross_charge":13.97,"discounted_cash":9.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"COLLAGENASE OINT 250 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00064501030","type":"CDM"},{"code":"00064501030","type":"NDC"}],"standard_charges":[{"gross_charge":565.34,"discounted_cash":395.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BETAXOLOL HCL OPHTH SUSP 0.25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00065024610","type":"CDM"},{"code":"00065024610","type":"NDC"}],"standard_charges":[{"gross_charge":918.09,"discounted_cash":642.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BRINZOLAMIDE OPHTH SUSP 1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00065027510","type":"CDM"},{"code":"00065027510","type":"NDC"}],"standard_charges":[{"gross_charge":959.18,"discounted_cash":671.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065039605","type":"CDM"},{"code":"00065039605","type":"NDC"}],"standard_charges":[{"gross_charge":211.05,"discounted_cash":147.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POVIDONE-IODINE OPHTH SOLN 5%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00065041130","type":"CDM"},{"code":"00065041130","type":"NDC"}],"standard_charges":[{"gross_charge":76.06,"discounted_cash":53.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065051801","type":"CDM"},{"code":"00065051801","type":"NDC"}],"standard_charges":[{"gross_charge":9.06,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION - EXTRAOCULAR","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00065053001","type":"CDM"},{"code":"00065053001","type":"NDC"}],"standard_charges":[{"gross_charge":25.32,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00065064305","type":"CDM"},{"code":"00065064305","type":"NDC"}],"standard_charges":[{"gross_charge":322.07,"discounted_cash":225.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH OINT 0.3%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00065065435","type":"CDM"},{"code":"00065065435","type":"NDC"}],"standard_charges":[{"gross_charge":620.5,"discounted_cash":434.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"APRACLONIDINE HCL OPHTH SOLN 1% (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00065066010","type":"CDM"},{"code":"00065066010","type":"NDC"}],"standard_charges":[{"gross_charge":57.79,"discounted_cash":40.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TETRACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00065074114","type":"CDM"},{"code":"00065074114","type":"NDC"}],"standard_charges":[{"gross_charge":85.43,"discounted_cash":59.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION - INTRAOCULAR","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00065079515","type":"CDM"},{"code":"00065079515","type":"NDC"}],"standard_charges":[{"gross_charge":51.33,"discounted_cash":35.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OPHTHALMIC IRRIGATION SOLUTION - INTRAOCULAR","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00065079550","type":"CDM"},{"code":"00065079550","type":"NDC"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":61.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00067512509","type":"CDM"},{"code":"00067512509","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | NDC EA = 1 PATCH"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx00067815203","type":"CDM"},{"code":"00067815203","type":"NDC"}],"standard_charges":[{"gross_charge":19.6,"discounted_cash":13.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00069020901","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069020901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069020901","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069020901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00069020910","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069020910","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069020910","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069020910","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00069024801","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069024801","type":"NDC"}],"standard_charges":[{"gross_charge":131.97,"discounted_cash":92.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00069024810","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00069024810","type":"NDC"}],"standard_charges":[{"gross_charge":141.51,"discounted_cash":99.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RITUXIMAB-PVVR IV SOLN 500 MG/50ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00069024901","type":"CDM"},{"code":"Q5119","type":"HCPCS"},{"code":"00069024901","type":"NDC"}],"standard_charges":[{"gross_charge":7715.46,"discounted_cash":5400.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM-AAFI SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00069029101","type":"CDM"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029101","type":"NDC"}],"standard_charges":[{"gross_charge":1013.58,"discounted_cash":709.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM-AAFI SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00069029110","type":"CDM"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029110","type":"NDC"}],"standard_charges":[{"gross_charge":1013.62,"discounted_cash":709.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM-AAFI SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx00069029201","type":"CDM"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029201","type":"NDC"}],"standard_charges":[{"gross_charge":1621.81,"discounted_cash":1135.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM-AAFI SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx00069029210","type":"CDM"},{"code":"Q5110","type":"HCPCS"},{"code":"00069029210","type":"NDC"}],"standard_charges":[{"gross_charge":1621.78,"discounted_cash":1135.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INFLIXIMAB-DYYB FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00069080901","type":"CDM"},{"code":"Q5103","type":"HCPCS"},{"code":"00069080901","type":"NDC"}],"standard_charges":[{"gross_charge":1683.44,"discounted_cash":1178.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130801","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130801","type":"NDC"}],"standard_charges":[{"gross_charge":1113.76,"discounted_cash":779.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130810","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130810","type":"NDC"}],"standard_charges":[{"gross_charge":1114.13,"discounted_cash":779.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPOETIN ALFA-EPBX INJ 40000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00069130901","type":"CDM"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130901","type":"NDC"}],"standard_charges":[{"gross_charge":1405.77,"discounted_cash":984.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069600102","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069600102","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00069600110","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"00069600110","type":"NDC"}],"standard_charges":[{"gross_charge":353.52,"discounted_cash":247.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071000740","type":"CDM"},{"code":"00071000740","type":"NDC"}],"standard_charges":[{"gross_charge":13.95,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071015723","type":"CDM"},{"code":"00071015723","type":"NDC"}],"standard_charges":[{"gross_charge":41.82,"discounted_cash":29.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071041813","type":"CDM"},{"code":"00071041813","type":"NDC"}],"standard_charges":[{"gross_charge":12.89,"discounted_cash":9.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071101268","type":"CDM"},{"code":"00071101268","type":"NDC"}],"standard_charges":[{"gross_charge":28.88,"discounted_cash":20.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00071101341","type":"CDM"},{"code":"00071101341","type":"NDC"}],"standard_charges":[{"gross_charge":30.61,"discounted_cash":21.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CISATRACURIUM BESYLATE IV SOLN 20 MG/10ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00074438010","type":"CDM"},{"code":"00074438010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074455211","type":"CDM"},{"code":"00074455211","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RISANKIZUMAB-RZAA IV SOLN 600 MG/10ML (60 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00074501501","type":"CDM"},{"code":"J2327","type":"HCPCS"},{"code":"00074501501","type":"NDC"}],"standard_charges":[{"gross_charge":34303.62,"discounted_cash":24012.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074659490","type":"CDM"},{"code":"00074659490","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074662411","type":"CDM"},{"code":"00074662411","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00074706911","type":"CDM"},{"code":"00074706911","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00075062040","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062040","type":"NDC"}],"standard_charges":[{"gross_charge":144.65,"discounted_cash":101.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00075062280","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062280","type":"NDC"}],"standard_charges":[{"gross_charge":253.46,"discounted_cash":177.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00075062300","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062300","type":"NDC"}],"standard_charges":[{"gross_charge":325.86,"discounted_cash":228.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00075062430","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075062430","type":"NDC"}],"standard_charges":[{"gross_charge":108.5,"discounted_cash":75.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx00075291201","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075291201","type":"NDC"}],"standard_charges":[{"gross_charge":398.42,"discounted_cash":278.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx00075291501","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00075291501","type":"NDC"}],"standard_charges":[{"gross_charge":470.86,"discounted_cash":329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078035834","type":"CDM"},{"code":"00078035834","type":"NDC"}],"standard_charges":[{"gross_charge":26.36,"discounted_cash":18.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00078043561","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"00078043561","type":"NDC"}],"standard_charges":[{"gross_charge":4751.6,"discounted_cash":3326.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078043905","type":"CDM"},{"code":"00078043905","type":"NDC"}],"standard_charges":[{"gross_charge":12.92,"discounted_cash":9.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 24-26 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078065920","type":"CDM"},{"code":"00078065920","type":"NDC"}],"standard_charges":[{"gross_charge":30.27,"discounted_cash":21.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BETAXOLOL HCL OPHTH SUSP 0.25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00078072910","type":"CDM"},{"code":"00078072910","type":"NDC"}],"standard_charges":[{"gross_charge":1121.61,"discounted_cash":785.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 49-51 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00078077720","type":"CDM"},{"code":"00078077720","type":"NDC"}],"standard_charges":[{"gross_charge":30.27,"discounted_cash":21.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL OPHTH OINT 0.3%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00078084101","type":"CDM"},{"code":"00078084101","type":"NDC"}],"standard_charges":[{"gross_charge":768.12,"discounted_cash":537.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN B OINT","drug_information":{"unit":28.3,"type":"GM"},"code_information":[{"code":"Rx00081079887","type":"CDM"},{"code":"00081079887","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00085113601","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"00085113601","type":"NDC"}],"standard_charges":[{"gross_charge":2051.42,"discounted_cash":1435.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085134106","type":"CDM"},{"code":"00085134106","type":"NDC"}],"standard_charges":[{"gross_charge":247.79,"discounted_cash":173.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 110 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00085146102","type":"CDM"},{"code":"00085146102","type":"NDC"}],"standard_charges":[{"gross_charge":523.9,"discounted_cash":366.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN GLARGINE SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00088221901","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00088221901","type":"NDC"}],"standard_charges":[{"gross_charge":364.95,"discounted_cash":255.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN GLARGINE SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00088221905","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00088221905","type":"NDC"}],"standard_charges":[{"gross_charge":260.28,"discounted_cash":182.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN GLARGINE INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00088222033","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00088222033","type":"NDC"}],"standard_charges":[{"gross_charge":867.62,"discounted_cash":607.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093005105","type":"CDM"},{"code":"00093005105","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093031901","type":"CDM"},{"code":"00093031901","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093081001","type":"CDM"},{"code":"00093081001","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093081101","type":"CDM"},{"code":"00093081101","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx00093202631","type":"CDM"},{"code":"00093202631","type":"NDC"}],"standard_charges":[{"gross_charge":19.47,"discounted_cash":13.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx00093202694","type":"CDM"},{"code":"00093202694","type":"NDC"}],"standard_charges":[{"gross_charge":22.57,"discounted_cash":15.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093220301","type":"CDM"},{"code":"00093220301","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093220401","type":"CDM"},{"code":"00093220401","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093221001","type":"CDM"},{"code":"00093221001","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093227534","type":"CDM"},{"code":"00093227534","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093292919","type":"CDM"},{"code":"00093292919","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICLOXACILLIN SODIUM CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093312301","type":"CDM"},{"code":"00093312301","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DISOPYRAMIDE PHOSPHATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093312701","type":"CDM"},{"code":"00093312701","type":"NDC"}],"standard_charges":[{"gross_charge":13.53,"discounted_cash":9.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093314501","type":"CDM"},{"code":"00093314501","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093314701","type":"CDM"},{"code":"00093314701","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":8.5,"type":"GM"},"code_information":[{"code":"Rx00093317431","type":"CDM"},{"code":"00093317431","type":"NDC"}],"standard_charges":[{"gross_charge":146.84,"discounted_cash":102.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093342601","type":"CDM"},{"code":"00093342601","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 5 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093365621","type":"CDM"},{"code":"00093365621","type":"NDC"}],"standard_charges":[{"gross_charge":74.69,"discounted_cash":52.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 5 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093365640","type":"CDM"},{"code":"00093365640","type":"NDC"}],"standard_charges":[{"gross_charge":76.53,"discounted_cash":53.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 125 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093412573","type":"CDM"},{"code":"00093412573","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN V POTASSIUM FOR SOLN 125 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093412574","type":"CDM"},{"code":"00093412574","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093415579","type":"CDM"},{"code":"00093415579","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093416173","type":"CDM"},{"code":"00093416173","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00093417773","type":"CDM"},{"code":"00093417773","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093524565","type":"CDM"},{"code":"00093524565","type":"NDC"}],"standard_charges":[{"gross_charge":13.18,"discounted_cash":9.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681619","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681619","type":"NDC"}],"standard_charges":[{"gross_charge":15.31,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681655","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681655","type":"NDC"}],"standard_charges":[{"gross_charge":16.23,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00093681673","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00093681673","type":"NDC"}],"standard_charges":[{"gross_charge":25.31,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093716356","type":"CDM"},{"code":"00093716356","type":"NDC"}],"standard_charges":[{"gross_charge":21.14,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEXILETINE HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093873901","type":"CDM"},{"code":"00093873901","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093902019","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00093902019","type":"NDC"}],"standard_charges":[{"gross_charge":13.46,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOSPORINE MODIFIED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00093902065","type":"CDM"},{"code":"J7502","type":"HCPCS"},{"code":"00093902065","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE POLACRILEX LOZENGE 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00113034403","type":"CDM"},{"code":"00113034403","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00115146853","type":"CDM"},{"code":"00115146853","type":"NDC"}],"standard_charges":[{"gross_charge":63.99,"discounted_cash":44.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00115146860","type":"CDM"},{"code":"00115146860","type":"NDC"}],"standard_charges":[{"gross_charge":63.83,"discounted_cash":44.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115155701","type":"CDM"},{"code":"00115155701","type":"NDC"}],"standard_charges":[{"gross_charge":18.27,"discounted_cash":12.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115166001","type":"CDM"},{"code":"00115166001","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115169606","type":"CDM"},{"code":"00115169606","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115180101","type":"CDM"},{"code":"00115180101","type":"NDC"}],"standard_charges":[{"gross_charge":11.77,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115262201","type":"CDM"},{"code":"00115262201","type":"NDC"}],"standard_charges":[{"gross_charge":14.34,"discounted_cash":10.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00115982201","type":"CDM"},{"code":"00115982201","type":"NDC"}],"standard_charges":[{"gross_charge":12.18,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 0.12%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00116200116","type":"CDM"},{"code":"00116200116","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00116400516","type":"CDM"},{"code":"00116400516","type":"NDC"}],"standard_charges":[{"gross_charge":10.87,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00121043130","type":"CDM"},{"code":"00121043130","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx00121050404","type":"CDM"},{"code":"00121050404","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOCUSATE SODIUM LIQUID 150 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121054410","type":"CDM"},{"code":"00121054410","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL LACTATE ORAL CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00121058104","type":"CDM"},{"code":"00121058104","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121059516","type":"CDM"},{"code":"00121059516","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121063805","type":"CDM"},{"code":"00121063805","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SOLN 160 MG/5ML","drug_information":{"unit":10.15625,"type":"ML"},"code_information":[{"code":"Rx00121065705","type":"CDM"},{"code":"00121065705","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121075908","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00121075908","type":"NDC"}],"standard_charges":[{"gross_charge":11.46,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00121077001","type":"CDM"},{"code":"00121077001","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121086505","type":"CDM"},{"code":"00121086505","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121086530","type":"CDM"},{"code":"00121086530","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00121086720","type":"CDM"},{"code":"00121086720","type":"NDC"}],"standard_charges":[{"gross_charge":13.55,"discounted_cash":9.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISOLONE SOLN 15 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121088516","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00121088516","type":"NDC"}],"standard_charges":[{"gross_charge":15.36,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121090315","type":"CDM"},{"code":"00121090315","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121090340","type":"CDM"},{"code":"00121090340","type":"NDC"}],"standard_charges":[{"gross_charge":12.17,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121090405","type":"CDM"},{"code":"00121090405","type":"NDC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":8.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121090494","type":"CDM"},{"code":"00121090494","type":"NDC"}],"standard_charges":[{"gross_charge":12.63,"discounted_cash":8.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121091400","type":"CDM"},{"code":"00121091400","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121091405","type":"CDM"},{"code":"00121091405","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROMETHAZINE HCL ORAL SOLN 6.25 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121092716","type":"CDM"},{"code":"Q0169","type":"HCPCS"},{"code":"00121092716","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00121097251","type":"CDM"},{"code":"00121097251","type":"NDC"}],"standard_charges":[{"gross_charge":91.81,"discounted_cash":64.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121102200","type":"CDM"},{"code":"00121102200","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121102205","type":"CDM"},{"code":"00121102205","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121115430","type":"CDM"},{"code":"00121115430","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121148800","type":"CDM"},{"code":"00121148800","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121148810","type":"CDM"},{"code":"00121148810","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121155010","type":"CDM"},{"code":"00121155010","type":"NDC"}],"standard_charges":[{"gross_charge":12.06,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121155040","type":"CDM"},{"code":"00121155040","type":"NDC"}],"standard_charges":[{"gross_charge":15.03,"discounted_cash":10.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121176130","type":"CDM"},{"code":"00121176130","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 400-400-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121176230","type":"CDM"},{"code":"00121176230","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":10.15,"type":"ML"},"code_information":[{"code":"Rx00121188211","type":"CDM"},{"code":"00121188211","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":10.15,"type":"ML"},"code_information":[{"code":"Rx00121188294","type":"CDM"},{"code":"00121188294","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121231650","type":"CDM"},{"code":"00121231650","type":"NDC"}],"standard_charges":[{"gross_charge":14.37,"discounted_cash":10.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121457715","type":"CDM"},{"code":"00121457715","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":8.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00121457730","type":"CDM"},{"code":"00121457730","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121467500","type":"CDM"},{"code":"00121467500","type":"NDC"}],"standard_charges":[{"gross_charge":12.56,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121467505","type":"CDM"},{"code":"00121467505","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121475905","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00121475905","type":"NDC"}],"standard_charges":[{"gross_charge":21.43,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121475950","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"00121475950","type":"NDC"}],"standard_charges":[{"gross_charge":21.85,"discounted_cash":15.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121477205","type":"CDM"},{"code":"00121477205","type":"NDC"}],"standard_charges":[{"gross_charge":18.54,"discounted_cash":12.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00121477405","type":"CDM"},{"code":"00121477405","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121477610","type":"CDM"},{"code":"00121477610","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121478505","type":"CDM"},{"code":"00121478505","type":"NDC"}],"standard_charges":[{"gross_charge":11.7,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121495015","type":"CDM"},{"code":"00121495015","type":"NDC"}],"standard_charges":[{"gross_charge":13.31,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00121495040","type":"CDM"},{"code":"00121495040","type":"NDC"}],"standard_charges":[{"gross_charge":13.4,"discounted_cash":9.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 10 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00121495594","type":"CDM"},{"code":"00121495594","type":"NDC"}],"standard_charges":[{"gross_charge":13.4,"discounted_cash":9.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCERIN SUPPOS 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00132007912","type":"CDM"},{"code":"00132007912","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MINERAL OIL ENEMA","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"Rx00132030140","type":"CDM"},{"code":"00132030140","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143117101","type":"CDM"},{"code":"00143117101","type":"NDC"}],"standard_charges":[{"gross_charge":11.88,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143124001","type":"CDM"},{"code":"00143124001","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143211250","type":"CDM"},{"code":"00143211250","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143226001","type":"CDM"},{"code":"00143226001","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143915301","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"00143915301","type":"NDC"}],"standard_charges":[{"gross_charge":164.46,"discounted_cash":115.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143915310","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"00143915310","type":"NDC"}],"standard_charges":[{"gross_charge":145.78,"discounted_cash":102.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143915601","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00143915601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143915610","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00143915610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143916201","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143916201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143916210","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143916210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143927301","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"00143927301","type":"NDC"}],"standard_charges":[{"gross_charge":1046.25,"discounted_cash":732.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143928401","type":"CDM"},{"code":"J2471","type":"HCPCS"},{"code":"00143928401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143928410","type":"CDM"},{"code":"J2471","type":"HCPCS"},{"code":"00143928410","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143929801","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00143929801","type":"NDC"}],"standard_charges":[{"gross_charge":114.08,"discounted_cash":79.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143930001","type":"CDM"},{"code":"J2471","type":"HCPCS"},{"code":"00143930001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143931001","type":"CDM"},{"code":"00143931001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143931010","type":"CDM"},{"code":"00143931010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143935701","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143935701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143935710","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00143935710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143950201","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"00143950201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143950301","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"00143950301","type":"NDC"}],"standard_charges":[{"gross_charge":357.11,"discounted_cash":249.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143950601","type":"CDM"},{"code":"00143950601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143950610","type":"CDM"},{"code":"00143950610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143950901","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143950901","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143950910","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143950910","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143956401","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"00143956401","type":"NDC"}],"standard_charges":[{"gross_charge":1741.3,"discounted_cash":1218.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143957001","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00143957001","type":"NDC"}],"standard_charges":[{"gross_charge":114.08,"discounted_cash":79.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143957010","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00143957010","type":"NDC"}],"standard_charges":[{"gross_charge":124.17,"discounted_cash":86.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143957501","type":"CDM"},{"code":"00143957501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143957510","type":"CDM"},{"code":"00143957510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143957701","type":"CDM"},{"code":"00143957701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143957710","type":"CDM"},{"code":"00143957710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143959401","type":"CDM"},{"code":"00143959401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143959425","type":"CDM"},{"code":"00143959425","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143959501","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00143959501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143962201","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00143962201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143963701","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143963701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143963710","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143963710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00143963801","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"00143963801","type":"NDC"}],"standard_charges":[{"gross_charge":123.79,"discounted_cash":86.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143968101","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00143968101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00143968201","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00143968201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143968310","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143968310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143968401","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143968401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143968410","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143968410","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143968901","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00143968901","type":"NDC"}],"standard_charges":[{"gross_charge":230.86,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00143968910","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"00143968910","type":"NDC"}],"standard_charges":[{"gross_charge":147.23,"discounted_cash":103.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00143972001","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972001","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00143972024","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"00143972024","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143972901","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"00143972901","type":"NDC"}],"standard_charges":[{"gross_charge":337.93,"discounted_cash":236.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERBUTALINE SULFATE INJ 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00143974601","type":"CDM"},{"code":"J3105","type":"HCPCS"},{"code":"00143974601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERBUTALINE SULFATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143974610","type":"CDM"},{"code":"J3105","type":"HCPCS"},{"code":"00143974610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143978310","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143978401","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00143978410","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978410","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143978501","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00143978510","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978601","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978610","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978701","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00143978710","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00143978710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143983701","type":"CDM"},{"code":"00143983701","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985601","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00143985601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985625","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00143985625","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985701","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00143985701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143985725","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00143985725","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00143987501","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00143987501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00143987510","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00143987510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00143987525","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"00143987525","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143987701","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"00143987701","type":"NDC"}],"standard_charges":[{"gross_charge":277.21,"discounted_cash":194.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143987725","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"00143987725","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143992390","type":"CDM"},{"code":"J0688","type":"HCPCS"},{"code":"00143992390","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143992490","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00143992490","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00143992701","type":"CDM"},{"code":"00143992701","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00143998250","type":"CDM"},{"code":"00143998250","type":"NDC"}],"standard_charges":[{"gross_charge":12.93,"discounted_cash":9.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168000415","type":"CDM"},{"code":"00168000415","type":"NDC"}],"standard_charges":[{"gross_charge":57.61,"discounted_cash":40.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168000715","type":"CDM"},{"code":"00168000715","type":"NDC"}],"standard_charges":[{"gross_charge":87.46,"discounted_cash":61.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.35,"type":"GM"},"code_information":[{"code":"Rx00168001531","type":"CDM"},{"code":"00168001531","type":"NDC"}],"standard_charges":[{"gross_charge":5.13,"discounted_cash":3.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIBUCAINE OINT 1%","drug_information":{"unit":28.35,"type":"GM"},"code_information":[{"code":"Rx00168004631","type":"CDM"},{"code":"00168004631","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WHITE PETROLATUM OINTMENT","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00168005345","type":"CDM"},{"code":"00168005345","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZINC OXIDE OINT 20%","drug_information":{"unit":28.35,"type":"GM"},"code_information":[{"code":"Rx00168006231","type":"CDM"},{"code":"00168006231","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE CREAM 100000-0.1 UNIT/GM-%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168008115","type":"CDM"},{"code":"00168008115","type":"NDC"}],"standard_charges":[{"gross_charge":229.2,"discounted_cash":160.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00168025815","type":"CDM"},{"code":"00168025815","type":"NDC"}],"standard_charges":[{"gross_charge":71.31,"discounted_cash":49.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00168035705","type":"CDM"},{"code":"00168035705","type":"NDC"}],"standard_charges":[{"gross_charge":74.78,"discounted_cash":52.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx00168035755","type":"CDM"},{"code":"00168035755","type":"NDC"}],"standard_charges":[{"gross_charge":74.78,"discounted_cash":52.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169183311","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169183311","type":"NDC"}],"standard_charges":[{"gross_charge":588.65,"discounted_cash":412.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR HUMAN INJ 100 UNIT/ML (70-30)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169183711","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169183711","type":"NDC"}],"standard_charges":[{"gross_charge":588.65,"discounted_cash":412.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN ASPART PROT & ASPART SUS PEN-INJ 100 UNIT/ML (70-30)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00169369619","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169369619","type":"NDC"}],"standard_charges":[{"gross_charge":218.58,"discounted_cash":153.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN ASPART INJ SOLN 100 UNIT/ML,INSULIN ASPART SOLN CARTRIDGE 100 UNIT/ML,INSULIN ASPART SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00169633910","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169633910","type":"NDC"}],"standard_charges":[{"gross_charge":218.58,"discounted_cash":153.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN ASPART INJ SOLN 100 UNIT/ML,INSULIN ASPART SOLN CARTRIDGE 100 UNIT/ML,INSULIN ASPART SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169750111","type":"CDM"},{"code":"J1817","type":"HCPCS"},{"code":"00169750111","type":"NDC"}],"standard_charges":[{"gross_charge":565.97,"discounted_cash":396.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN ASPART INJ SOLN 100 UNIT/ML,INSULIN ASPART SOLN CARTRIDGE 100 UNIT/ML,INSULIN ASPART SOLN PEN-INJECTOR 100 UNIT/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00169750111","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00169750111","type":"NDC"}],"standard_charges":[{"gross_charge":565.97,"discounted_cash":396.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172392560","type":"CDM"},{"code":"00172392560","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172409660","type":"CDM"},{"code":"00172409660","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172409680","type":"CDM"},{"code":"00172409680","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00172572860","type":"CDM"},{"code":"00172572860","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":8.0,"type":"GM"},"code_information":[{"code":"Rx00173068224","type":"CDM"},{"code":"00173068224","type":"NDC"}],"standard_charges":[{"gross_charge":109.88,"discounted_cash":76.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173071215","type":"CDM"},{"code":"00173071215","type":"NDC"}],"standard_charges":[{"gross_charge":24.42,"discounted_cash":17.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173073601","type":"CDM"},{"code":"00173073601","type":"NDC"}],"standard_charges":[{"gross_charge":138.65,"discounted_cash":97.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"UMECLIDINIUM-VILANTEROL AERO POWD BA 62.5-25 MCG/ACT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173086906","type":"CDM"},{"code":"00173086906","type":"NDC"}],"standard_charges":[{"gross_charge":63.1,"discounted_cash":44.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUTICASONE-UMECLIDINIUM-VILANTEROL AEPB 200-62.5-25 MCG/ACT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173089314","type":"CDM"},{"code":"00173089314","type":"NDC"}],"standard_charges":[{"gross_charge":64.4,"discounted_cash":45.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00173093356","type":"CDM"},{"code":"00173093356","type":"NDC"}],"standard_charges":[{"gross_charge":32.24,"discounted_cash":22.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185012901","type":"CDM"},{"code":"00185012901","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185014501","type":"CDM"},{"code":"00185014501","type":"NDC"}],"standard_charges":[{"gross_charge":10.91,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CILOSTAZOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185022360","type":"CDM"},{"code":"00185022360","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185041560","type":"CDM"},{"code":"00185041560","type":"NDC"}],"standard_charges":[{"gross_charge":10.89,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185067401","type":"CDM"},{"code":"00185067401","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOLAZONE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00185505001","type":"CDM"},{"code":"00185505001","type":"NDC"}],"standard_charges":[{"gross_charge":10.54,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 160-4.5 MCG/ACT","drug_information":{"unit":10.2,"type":"GM"},"code_information":[{"code":"Rx00186037020","type":"CDM"},{"code":"00186037020","type":"NDC"}],"standard_charges":[{"gross_charge":669.14,"discounted_cash":468.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 160-4.5 MCG/ACT","drug_information":{"unit":6.0,"type":"GM"},"code_information":[{"code":"Rx00186037028","type":"CDM"},{"code":"00186037028","type":"NDC"}],"standard_charges":[{"gross_charge":211.59,"discounted_cash":148.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 80-4.5 MCG/ACT","drug_information":{"unit":10.2,"type":"GM"},"code_information":[{"code":"Rx00186037220","type":"CDM"},{"code":"00186037220","type":"NDC"}],"standard_charges":[{"gross_charge":591.74,"discounted_cash":414.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 80-4.5 MCG/ACT","drug_information":{"unit":6.9,"type":"GM"},"code_information":[{"code":"Rx00186037228","type":"CDM"},{"code":"00186037228","type":"NDC"}],"standard_charges":[{"gross_charge":211.59,"discounted_cash":148.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TICAGRELOR TAB 90 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00186077760","type":"CDM"},{"code":"00186077760","type":"NDC"}],"standard_charges":[{"gross_charge":23.33,"discounted_cash":16.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00186198904","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00186198904","type":"NDC"}],"standard_charges":[{"gross_charge":27.69,"discounted_cash":19.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM RECTAL GEL DELIVERY SYSTEM 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00187065820","type":"CDM"},{"code":"00187065820","type":"NDC"}],"standard_charges":[{"gross_charge":404.18,"discounted_cash":282.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00206240401","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206240401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00206240501","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206240501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00206885208","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206885208","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00206885216","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206885216","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00206885408","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206885408","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00206885416","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206885416","type":"NDC"}],"standard_charges":[{"gross_charge":134.75,"discounted_cash":94.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00206885508","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206885508","type":"NDC"}],"standard_charges":[{"gross_charge":480.33,"discounted_cash":336.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00206885516","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206885516","type":"NDC"}],"standard_charges":[{"gross_charge":179.57,"discounted_cash":125.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD IN DEX IV SOL 3-0.375GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00206886101","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206886101","type":"NDC"}],"standard_charges":[{"gross_charge":151.98,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD IN DEX IV SOL 3-0.375GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00206886102","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00206886102","type":"NDC"}],"standard_charges":[{"gross_charge":151.98,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00223172101","type":"CDM"},{"code":"00223172101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00223176001","type":"CDM"},{"code":"00223176001","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PSYLLIUM POWDER PACKET 100%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00224180100","type":"CDM"},{"code":"00224180100","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PSYLLIUM POWDER PACKET 100%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00224180124","type":"CDM"},{"code":"00224180124","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL NASAL SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00225080547","type":"CDM"},{"code":"00225080547","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":3.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228212710","type":"CDM"},{"code":"00228212710","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228287911","type":"CDM"},{"code":"00228287911","type":"NDC"}],"standard_charges":[{"gross_charge":13.67,"discounted_cash":9.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00228300311","type":"CDM"},{"code":"00228300311","type":"NDC"}],"standard_charges":[{"gross_charge":11.59,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 4%","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx00234057504","type":"CDM"},{"code":"00234057504","type":"NDC"}],"standard_charges":[{"gross_charge":5.19,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245001289","type":"CDM"},{"code":"00245001289","type":"NDC"}],"standard_charges":[{"gross_charge":12.31,"discounted_cash":8.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245036089","type":"CDM"},{"code":"00245036089","type":"NDC"}],"standard_charges":[{"gross_charge":16.68,"discounted_cash":11.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531710","type":"CDM"},{"code":"00245531710","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00245531789","type":"CDM"},{"code":"00245531789","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":6.7,"type":"GM"},"code_information":[{"code":"Rx00254100752","type":"CDM"},{"code":"00254100752","type":"NDC"}],"standard_charges":[{"gross_charge":146.15,"discounted_cash":102.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00264151032","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00264151032","type":"NDC"}],"standard_charges":[{"gross_charge":151.79,"discounted_cash":106.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264151032","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00264151032","type":"NDC"}],"standard_charges":[{"gross_charge":146.72,"discounted_cash":102.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00264180032","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00264180032","type":"NDC"}],"standard_charges":[{"gross_charge":149.06,"discounted_cash":104.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00264420452","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00264420452","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264751010","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00264751010","type":"NDC"}],"standard_charges":[{"gross_charge":152.96,"discounted_cash":107.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264761000","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00264761000","type":"NDC"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00264780010","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00264780010","type":"NDC"}],"standard_charges":[{"gross_charge":151.99,"discounted_cash":106.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264780020","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00264780020","type":"NDC"}],"standard_charges":[{"gross_charge":149.55,"discounted_cash":104.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE IV INFUSION IN D5W INJ 8 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00264959820","type":"CDM"},{"code":"J2002","type":"HCPCS"},{"code":"00264959820","type":"NDC"}],"standard_charges":[{"gross_charge":158.81,"discounted_cash":111.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 61%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00270131535","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131535","type":"NDC"}],"standard_charges":[{"gross_charge":99.6,"discounted_cash":69.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 61%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00270131550","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131550","type":"NDC"}],"standard_charges":[{"gross_charge":145.35,"discounted_cash":101.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 76%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00270131635","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131635","type":"NDC"}],"standard_charges":[{"gross_charge":116.1,"discounted_cash":81.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IOPAMIDOL IV SOLN 76%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00270131637","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131637","type":"NDC"}],"standard_charges":[{"gross_charge":160.65,"discounted_cash":112.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GADOBENATE DIMEGLUMINE IV SOLN 529 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00270516415","type":"CDM"},{"code":"A9577","type":"HCPCS"},{"code":"00270516415","type":"NDC"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00280211010","type":"CDM"},{"code":"00280211010","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROGLYCERIN OINT 2%","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx00281032608","type":"CDM"},{"code":"00281032608","type":"NDC"}],"standard_charges":[{"gross_charge":13.89,"discounted_cash":9.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZOCAINE DENTAL SOLN 20%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00283061043","type":"CDM"},{"code":"00283061043","type":"NDC"}],"standard_charges":[{"gross_charge":9.66,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZOCAINE MOUTH/THROAT AEROSOL 20%","drug_information":{"unit":57.0,"type":"GM"},"code_information":[{"code":"Rx00283067902","type":"CDM"},{"code":"00283067902","type":"NDC"}],"standard_charges":[{"gross_charge":27.98,"discounted_cash":19.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310075139","type":"CDM"},{"code":"00310075139","type":"NDC"}],"standard_charges":[{"gross_charge":25.21,"discounted_cash":17.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00310075190","type":"CDM"},{"code":"00310075190","type":"NDC"}],"standard_charges":[{"gross_charge":25.72,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 160-4.5 MCG/ACT","drug_information":{"unit":10.2,"type":"GM"},"code_information":[{"code":"Rx00310737020","type":"CDM"},{"code":"00310737020","type":"NDC"}],"standard_charges":[{"gross_charge":682.07,"discounted_cash":477.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICONAZOLE NITRATE POWDER 2%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx00316022530","type":"CDM"},{"code":"00316022530","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338001702","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001702","type":"NDC"}],"standard_charges":[{"gross_charge":146.62,"discounted_cash":102.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338001703","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001703","type":"NDC"}],"standard_charges":[{"gross_charge":147.11,"discounted_cash":102.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338001704","type":"CDM"},{"code":"J7070","type":"HCPCS"},{"code":"00338001704","type":"NDC"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338001741","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001741","type":"NDC"}],"standard_charges":[{"gross_charge":147.01,"discounted_cash":102.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338001741","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001741","type":"NDC"}],"standard_charges":[{"gross_charge":158.32,"discounted_cash":110.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00338001748","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001748","type":"NDC"}],"standard_charges":[{"gross_charge":152.96,"discounted_cash":107.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338001748","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00338001748","type":"NDC"}],"standard_charges":[{"gross_charge":147.11,"discounted_cash":102.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338002302","type":"CDM"},{"code":"00338002302","type":"NDC"}],"standard_charges":[{"gross_charge":148.57,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338002303","type":"CDM"},{"code":"00338002303","type":"NDC"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338002304","type":"CDM"},{"code":"00338002304","type":"NDC"}],"standard_charges":[{"gross_charge":148.67,"discounted_cash":104.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338002304","type":"CDM"},{"code":"00338002304","type":"NDC"}],"standard_charges":[{"gross_charge":162.11,"discounted_cash":113.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004303","type":"CDM"},{"code":"00338004303","type":"NDC"}],"standard_charges":[{"gross_charge":146.62,"discounted_cash":102.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338004303","type":"CDM"},{"code":"00338004303","type":"NDC"}],"standard_charges":[{"gross_charge":149.06,"discounted_cash":104.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004304","type":"CDM"},{"code":"00338004304","type":"NDC"}],"standard_charges":[{"gross_charge":145.65,"discounted_cash":101.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338004304","type":"CDM"},{"code":"00338004304","type":"NDC"}],"standard_charges":[{"gross_charge":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IRRIGATION SOLN 0.9%","drug_information":{"unit":3000.0,"type":"ML"},"code_information":[{"code":"Rx00338004747","type":"CDM"},{"code":"00338004747","type":"NDC"}],"standard_charges":[{"gross_charge":161.74,"discounted_cash":113.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004901","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004901","type":"NDC"}],"standard_charges":[{"gross_charge":148.57,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00338004901","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004901","type":"NDC"}],"standard_charges":[{"gross_charge":146.82,"discounted_cash":102.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004902","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004902","type":"NDC"}],"standard_charges":[{"gross_charge":146.62,"discounted_cash":102.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338004903","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00338004903","type":"NDC"}],"standard_charges":[{"gross_charge":147.11,"discounted_cash":102.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338004904","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00338004904","type":"NDC"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004911","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004911","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338004911","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004911","type":"NDC"}],"standard_charges":[{"gross_charge":146.92,"discounted_cash":102.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338004918","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004918","type":"NDC"}],"standard_charges":[{"gross_charge":146.92,"discounted_cash":102.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338004938","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004938","type":"NDC"}],"standard_charges":[{"gross_charge":146.72,"discounted_cash":102.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338004941","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004941","type":"NDC"}],"standard_charges":[{"gross_charge":157.35,"discounted_cash":110.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338004941","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004941","type":"NDC"}],"standard_charges":[{"gross_charge":146.82,"discounted_cash":102.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338004948","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338004948","type":"NDC"}],"standard_charges":[{"gross_charge":147.11,"discounted_cash":102.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx00338007225","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00338007225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.2%,DEXTROSE 5% W/ SODIUM CHLORIDE 0.225%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338007703","type":"CDM"},{"code":"00338007703","type":"NDC"}],"standard_charges":[{"gross_charge":149.06,"discounted_cash":104.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338008503","type":"CDM"},{"code":"00338008503","type":"NDC"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338008504","type":"CDM"},{"code":"00338008504","type":"NDC"}],"standard_charges":[{"gross_charge":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338008904","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00338008904","type":"NDC"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338008904","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00338008904","type":"NDC"}],"standard_charges":[{"gross_charge":146.14,"discounted_cash":102.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NOREPINEPHRINE-DEXTROSE IV SOLUTION 4 MG/250ML-5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338011220","type":"CDM"},{"code":"00338011220","type":"NDC"}],"standard_charges":[{"gross_charge":227.59,"discounted_cash":159.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00338011703","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00338011703","type":"NDC"}],"standard_charges":[{"gross_charge":147.11,"discounted_cash":102.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338011704","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00338011704","type":"NDC"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% IN LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338012504","type":"CDM"},{"code":"J7121","type":"HCPCS"},{"code":"00338012504","type":"NDC"}],"standard_charges":[{"gross_charge":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INSULIN REGULAR (HUMAN) IN NACL 0.9% IV SOLN 100 UNIT/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338012612","type":"CDM"},{"code":"J1815","type":"HCPCS"},{"code":"00338012612","type":"NDC"}],"standard_charges":[{"gross_charge":226.82,"discounted_cash":158.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MANNITOL IV SOLN 20%","drug_information":{"unit":62.5,"type":"ML"},"code_information":[{"code":"Rx00338035703","type":"CDM"},{"code":"J2151","type":"HCPCS"},{"code":"00338035703","type":"NDC"}],"standard_charges":[{"gross_charge":151.01,"discounted_cash":105.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE IV INFUSION IN D5W INJ 8 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338041102","type":"CDM"},{"code":"J2002","type":"HCPCS"},{"code":"00338041102","type":"NDC"}],"standard_charges":[{"gross_charge":151.5,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338051909","type":"CDM"},{"code":"00338051909","type":"NDC"}],"standard_charges":[{"gross_charge":243.02,"discounted_cash":170.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00338051958","type":"CDM"},{"code":"00338051958","type":"NDC"}],"standard_charges":[{"gross_charge":555.48,"discounted_cash":388.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338055311","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338055311","type":"NDC"}],"standard_charges":[{"gross_charge":149.55,"discounted_cash":104.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338055318","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00338055318","type":"NDC"}],"standard_charges":[{"gross_charge":149.45,"discounted_cash":104.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338067104","type":"CDM"},{"code":"00338067104","type":"NDC"}],"standard_charges":[{"gross_charge":150.04,"discounted_cash":105.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338067504","type":"CDM"},{"code":"00338067504","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN NACL 0.9% INJ,KCL 20 MEQ/L (0.149%) IN NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338069104","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338069104","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ,KCL 40 MEQ/L (0.298%) IN NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338069504","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338069504","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338070541","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338070541","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338070948","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00338070948","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338080304","type":"CDM"},{"code":"00338080304","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00338080704","type":"CDM"},{"code":"00338080704","type":"NDC"}],"standard_charges":[{"gross_charge":168.33,"discounted_cash":117.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOPAMINE IN DEXTROSE 5% INJ 1.6 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338100702","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00338100702","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN G POTASSIUM INJ 60000 UNIT/ML IN DEXTROSE","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338102541","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"00338102541","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROGLYCERIN IV SOLN 200 MCG/ML IN D5W","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338104902","type":"CDM"},{"code":"J2305","type":"HCPCS"},{"code":"00338104902","type":"NDC"}],"standard_charges":[{"gross_charge":186.82,"discounted_cash":130.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338105548","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00338105548","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 4 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00338107702","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00338107702","type":"NDC"}],"standard_charges":[{"gross_charge":254.59,"discounted_cash":178.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338170940","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00338170940","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL-DEXTROSE IV SOLN 1 GM/200ML-5%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00338355248","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00338355248","type":"NDC"}],"standard_charges":[{"gross_charge":555.48,"discounted_cash":388.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338361224","type":"CDM"},{"code":"J0737","type":"HCPCS"},{"code":"00338361224","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338361250","type":"CDM"},{"code":"J0737","type":"HCPCS"},{"code":"00338361250","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338381424","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00338381424","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00338381450","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00338381450","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338604648","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00338604648","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00338955712","type":"CDM"},{"code":"00338955712","type":"NDC"}],"standard_charges":[{"gross_charge":253.05,"discounted_cash":177.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000","drug_information":{"unit":1.8,"type":"ML"},"code_information":[{"code":"Rx00362901150","type":"CDM"},{"code":"00362901150","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378003201","type":"CDM"},{"code":"00378003201","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378007801","type":"CDM"},{"code":"00378007801","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INDAPAMIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378008001","type":"CDM"},{"code":"00378008001","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378018301","type":"CDM"},{"code":"00378018301","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378022893","type":"CDM"},{"code":"00378022893","type":"NDC"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378041501","type":"CDM"},{"code":"00378041501","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":8.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378087116","type":"CDM"},{"code":"00378087116","type":"NDC"}],"standard_charges":[{"gross_charge":40.33,"discounted_cash":28.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378087199","type":"CDM"},{"code":"00378087199","type":"NDC"}],"standard_charges":[{"gross_charge":55.55,"discounted_cash":38.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378092393","type":"CDM"},{"code":"00378092393","type":"NDC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":8.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378092493","type":"CDM"},{"code":"J0571","type":"HCPCS"},{"code":"00378092493","type":"NDC"}],"standard_charges":[{"gross_charge":14.44,"discounted_cash":10.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378161001","type":"CDM"},{"code":"00378161001","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378180077","type":"CDM"},{"code":"00378180077","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378253701","type":"CDM"},{"code":"00378253701","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378335099","type":"CDM"},{"code":"00378335099","type":"NDC"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":29.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378340293","type":"CDM"},{"code":"00378340293","type":"NDC"}],"standard_charges":[{"gross_charge":21.2,"discounted_cash":14.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378342201","type":"CDM"},{"code":"00378342201","type":"NDC"}],"standard_charges":[{"gross_charge":14.54,"discounted_cash":10.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378362777","type":"CDM"},{"code":"00378362777","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378427593","type":"CDM"},{"code":"00378427593","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378511001","type":"CDM"},{"code":"00378511001","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378530501","type":"CDM"},{"code":"00378530501","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GATIFLOXACIN OPHTH SOLN 0.5%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00378543135","type":"CDM"},{"code":"00378543135","type":"NDC"}],"standard_charges":[{"gross_charge":301.85,"discounted_cash":211.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOLAZONE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378617201","type":"CDM"},{"code":"00378617201","type":"NDC"}],"standard_charges":[{"gross_charge":13.21,"discounted_cash":9.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378623201","type":"CDM"},{"code":"00378623201","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378661001","type":"CDM"},{"code":"00378661001","type":"NDC"}],"standard_charges":[{"gross_charge":14.19,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LANSOPRAZOLE TAB DELAYED RELEASE ORALLY DISINTEGRATING 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378698132","type":"CDM"},{"code":"00378698132","type":"NDC"}],"standard_charges":[{"gross_charge":8.36,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LANSOPRAZOLE TAB DELAYED RELEASE ORALLY DISINTEGRATING 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378698188","type":"CDM"},{"code":"00378698188","type":"NDC"}],"standard_charges":[{"gross_charge":8.27,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":1.2,"type":"EA"},"code_information":[{"code":"Rx00378699331","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"00378699331","type":"NDC"}],"standard_charges":[{"gross_charge":15.3,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":30.0,"type":"EA"},"code_information":[{"code":"Rx00378699393","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"00378699393","type":"NDC"}],"standard_charges":[{"gross_charge":270.87,"discounted_cash":189.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00378699889","type":"CDM"},{"code":"00378699889","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378710077","type":"CDM"},{"code":"00378710077","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378773293","type":"CDM"},{"code":"00378773293","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR OINT 5%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00378870006","type":"CDM"},{"code":"00378870006","type":"NDC"}],"standard_charges":[{"gross_charge":248.51,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOSPORINE (OPHTH) EMULSION 0.05%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378876098","type":"CDM"},{"code":"00378876098","type":"NDC"}],"standard_charges":[{"gross_charge":14.65,"discounted_cash":10.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.1 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378910216","type":"CDM"},{"code":"00378910216","type":"NDC"}],"standard_charges":[{"gross_charge":11.01,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.1 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378910293","type":"CDM"},{"code":"00378910293","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911916","type":"CDM"},{"code":"00378911916","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":28.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378911998","type":"CDM"},{"code":"00378911998","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":28.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912116","type":"CDM"},{"code":"00378912116","type":"NDC"}],"standard_charges":[{"gross_charge":23.89,"discounted_cash":16.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912198","type":"CDM"},{"code":"00378912198","type":"NDC"}],"standard_charges":[{"gross_charge":23.93,"discounted_cash":16.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912216","type":"CDM"},{"code":"00378912216","type":"NDC"}],"standard_charges":[{"gross_charge":33.49,"discounted_cash":23.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912298","type":"CDM"},{"code":"00378912298","type":"NDC"}],"standard_charges":[{"gross_charge":33.56,"discounted_cash":23.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912416","type":"CDM"},{"code":"00378912416","type":"NDC"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":41.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00378912498","type":"CDM"},{"code":"00378912498","type":"NDC"}],"standard_charges":[{"gross_charge":59.46,"discounted_cash":41.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378967131","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"00378967131","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00378967193","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"00378967193","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENTAFLUOROPROPANE-TETRAFLUOROETHANE AERO SPRAY","drug_information":{"unit":116.0,"type":"ML"},"code_information":[{"code":"Rx00386000404","type":"CDM"},{"code":"00386000404","type":"NDC"}],"standard_charges":[{"gross_charge":33.06,"discounted_cash":23.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCERIN LIQUID","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00395103116","type":"CDM"},{"code":"00395103116","type":"NDC"}],"standard_charges":[{"gross_charge":23.65,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHERRY SYRUP","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00395266216","type":"CDM"},{"code":"00395266216","type":"NDC"}],"standard_charges":[{"gross_charge":14.19,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012323","type":"CDM"},{"code":"00406012323","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012362","type":"CDM"},{"code":"00406012362","type":"NDC"}],"standard_charges":[{"gross_charge":12.44,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012501","type":"CDM"},{"code":"00406012501","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012523","type":"CDM"},{"code":"00406012523","type":"NDC"}],"standard_charges":[{"gross_charge":12.38,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406012562","type":"CDM"},{"code":"00406012562","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":8.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406048423","type":"CDM"},{"code":"00406048423","type":"NDC"}],"standard_charges":[{"gross_charge":12.19,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE TAB 300-30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406048462","type":"CDM"},{"code":"00406048462","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406051201","type":"CDM"},{"code":"00406051201","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406051223","type":"CDM"},{"code":"00406051223","type":"NDC"}],"standard_charges":[{"gross_charge":12.22,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406051262","type":"CDM"},{"code":"00406051262","type":"NDC"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406055223","type":"CDM"},{"code":"00406055223","type":"NDC"}],"standard_charges":[{"gross_charge":11.78,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406055262","type":"CDM"},{"code":"00406055262","type":"NDC"}],"standard_charges":[{"gross_charge":12.37,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406114201","type":"CDM"},{"code":"00406114201","type":"NDC"}],"standard_charges":[{"gross_charge":11.88,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406575523","type":"CDM"},{"code":"00406575523","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406575562","type":"CDM"},{"code":"00406575562","type":"NDC"}],"standard_charges":[{"gross_charge":12.17,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406577123","type":"CDM"},{"code":"00406577123","type":"NDC"}],"standard_charges":[{"gross_charge":11.93,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406577162","type":"CDM"},{"code":"00406577162","type":"NDC"}],"standard_charges":[{"gross_charge":12.14,"discounted_cash":8.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00406800330","type":"CDM"},{"code":"00406800330","type":"NDC"}],"standard_charges":[{"gross_charge":11.77,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406831501","type":"CDM"},{"code":"00406831501","type":"NDC"}],"standard_charges":[{"gross_charge":12.7,"discounted_cash":8.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406831523","type":"CDM"},{"code":"00406831523","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406831562","type":"CDM"},{"code":"00406831562","type":"NDC"}],"standard_charges":[{"gross_charge":13.23,"discounted_cash":9.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406833023","type":"CDM"},{"code":"00406833023","type":"NDC"}],"standard_charges":[{"gross_charge":13.9,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406833062","type":"CDM"},{"code":"00406833062","type":"NDC"}],"standard_charges":[{"gross_charge":13.9,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406839023","type":"CDM"},{"code":"00406839023","type":"NDC"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":12.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406839062","type":"CDM"},{"code":"00406839062","type":"NDC"}],"standard_charges":[{"gross_charge":18.42,"discounted_cash":12.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406851501","type":"CDM"},{"code":"00406851501","type":"NDC"}],"standard_charges":[{"gross_charge":12.09,"discounted_cash":8.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406851523","type":"CDM"},{"code":"00406851523","type":"NDC"}],"standard_charges":[{"gross_charge":13.14,"discounted_cash":9.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406851562","type":"CDM"},{"code":"00406851562","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":9.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406900076","type":"CDM"},{"code":"00406900076","type":"NDC"}],"standard_charges":[{"gross_charge":59.12,"discounted_cash":41.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00406905076","type":"CDM"},{"code":"00406905076","type":"NDC"}],"standard_charges":[{"gross_charge":33.4,"discounted_cash":23.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00407141310","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141310","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IOHEXOL INJ 300 MG/ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00407141361","type":"CDM"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141361","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409000701","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409000701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409000710","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409000710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409012501","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409012501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409012525","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409012525","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409015201","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409015201","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409015224","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409015224","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409082901","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00409082901","type":"NDC"}],"standard_charges":[{"gross_charge":360.38,"discounted_cash":252.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409082911","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"00409082911","type":"NDC"}],"standard_charges":[{"gross_charge":421.74,"discounted_cash":295.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409106720","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"00409106720","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409114402","type":"CDM"},{"code":"00409114402","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409114405","type":"CDM"},{"code":"00409114405","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409114462","type":"CDM"},{"code":"00409114462","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115901","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115902","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115902","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409115918","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409115918","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116001","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116201","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116202","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116202","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116218","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116218","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116219","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116219","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116502","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116502","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409116519","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409116519","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409117603","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00409117603","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409117630","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00409117630","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409120703","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00409120703","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409120713","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00409120713","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409120715","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"00409120715","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409121501","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00409121501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409121521","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00409121521","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409127303","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"00409127303","type":"NDC"}],"standard_charges":[{"gross_charge":168.35,"discounted_cash":117.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409127332","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"00409127332","type":"NDC"}],"standard_charges":[{"gross_charge":168.35,"discounted_cash":117.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128303","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128303","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128304","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128304","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128305","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128305","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409128331","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409128331","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 60 MG/3ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 200 MG/10ML (2%),LIDOCAINE HCL LOCAL IV SOLN PREF SYRINGE 100 MG/5ML (2%)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409132305","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409132305","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409139021","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00409139021","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409141204","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00409141204","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409141210","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00409141210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409141234","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00409141234","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409141240","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00409141240","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409156010","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409156010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409156018","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409156018","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409156029","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409156029","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409158229","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409158229","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409161050","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409161050","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUTORPHANOL TARTRATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409162301","type":"CDM"},{"code":"J0595","type":"HCPCS"},{"code":"00409162301","type":"NDC"}],"standard_charges":[{"gross_charge":152.44,"discounted_cash":106.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUTORPHANOL TARTRATE INJ 1 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409162321","type":"CDM"},{"code":"J0595","type":"HCPCS"},{"code":"00409162321","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUTORPHANOL TARTRATE INJ 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409162601","type":"CDM"},{"code":"J0595","type":"HCPCS"},{"code":"00409162601","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUTORPHANOL TARTRATE INJ 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409162602","type":"CDM"},{"code":"J0595","type":"HCPCS"},{"code":"00409162602","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUTORPHANOL TARTRATE INJ 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409162621","type":"CDM"},{"code":"J0595","type":"HCPCS"},{"code":"00409162621","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409163010","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00409163010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409163015","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00409163015","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409163110","type":"CDM"},{"code":"00409163110","type":"NDC"}],"standard_charges":[{"gross_charge":183.96,"discounted_cash":128.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409163201","type":"CDM"},{"code":"00409163201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409163249","type":"CDM"},{"code":"00409163249","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174670","type":"CDM"},{"code":"00409174670","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409174929","type":"CDM"},{"code":"00409174929","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 25%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409177510","type":"CDM"},{"code":"00409177510","type":"NDC"}],"standard_charges":[{"gross_charge":178.74,"discounted_cash":125.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00409177805","type":"CDM"},{"code":"00409177805","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00409177815","type":"CDM"},{"code":"00409177815","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409188602","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"00409188602","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409188622","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"00409188622","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189001","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189001","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409189003","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189003","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409189101","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189101","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409189103","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189103","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00409189103","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189103","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN PF 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00409189113","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409189113","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCAINAMIDE HCL INJ 100 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409190201","type":"CDM"},{"code":"J2690","type":"HCPCS"},{"code":"00409190201","type":"NDC"}],"standard_charges":[{"gross_charge":1522.41,"discounted_cash":1065.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409198530","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00409198530","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00409201605","type":"CDM"},{"code":"00409201605","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00409201610","type":"CDM"},{"code":"00409201610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 1 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00409202902","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409202902","type":"NDC"}],"standard_charges":[{"gross_charge":108.31,"discounted_cash":75.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409205105","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409205105","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409205115","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00409205115","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409206605","type":"CDM"},{"code":"00409206605","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409206610","type":"CDM"},{"code":"00409206610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409226720","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"00409226720","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230801","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230801","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409230801","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230801","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230821","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230821","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409230821","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230821","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230849","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230849","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409230849","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230849","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409230869","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230869","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409230869","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00409230869","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409234401","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234401","type":"NDC"}],"standard_charges":[{"gross_charge":110.02,"discounted_cash":77.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOBUTAMINE HCL INJ 12.5 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409234462","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409234462","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409255201","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409255201","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409272301","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409272330","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409272330","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR IV SOLN 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409298703","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00409298703","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317801","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409317816","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409317816","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409318301","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"00409318301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409321312","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"00409321312","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409330001","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409330001","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409330024","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409330024","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 10%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409330703","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00409330703","type":"NDC"}],"standard_charges":[{"gross_charge":11.18,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 10%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409330711","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00409330711","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409330803","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00409330803","type":"NDC"}],"standard_charges":[{"gross_charge":12.85,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409337504","type":"CDM"},{"code":"00409337504","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409341401","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00409341401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409341411","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00409341411","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409341418","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00409341418","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409341421","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00409341421","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409351501","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409351501","type":"NDC"}],"standard_charges":[{"gross_charge":180.94,"discounted_cash":126.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409351511","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409351511","type":"NDC"}],"standard_charges":[{"gross_charge":202.43,"discounted_cash":141.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE 0.75% IN DEXTROSE INJ 8.25%","drug_information":{"unit":0.666666666666667,"type":"ML"},"code_information":[{"code":"Rx00409361301","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"00409361301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOBUTAMINE IN DEXTROSE 5% INJ 4 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409372432","type":"CDM"},{"code":"J1250","type":"HCPCS"},{"code":"00409372432","type":"NDC"}],"standard_charges":[{"gross_charge":408.89,"discounted_cash":286.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx00409379519","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"00409379519","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 0.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409381412","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00409381412","type":"NDC"}],"standard_charges":[{"gross_charge":284.37,"discounted_cash":199.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00409381511","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409381511","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409381512","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00409381512","type":"NDC"}],"standard_charges":[{"gross_charge":282.06,"discounted_cash":197.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409420801","type":"CDM"},{"code":"00409420801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409420810","type":"CDM"},{"code":"00409420810","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409426401","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409426401","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409426411","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00409426411","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427601","type":"CDM"},{"code":"00409427601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427602","type":"CDM"},{"code":"00409427602","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427616","type":"CDM"},{"code":"00409427616","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409427801","type":"CDM"},{"code":"00409427801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427902","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409427902","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409427916","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409427916","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409428201","type":"CDM"},{"code":"00409428201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409428202","type":"CDM"},{"code":"00409428202","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409428212","type":"CDM"},{"code":"00409428212","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409433201","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409433201","type":"NDC"}],"standard_charges":[{"gross_charge":114.87,"discounted_cash":80.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL IV FOR SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409435003","type":"CDM"},{"code":"00409435003","type":"NDC"}],"standard_charges":[{"gross_charge":127.99,"discounted_cash":89.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL IV FOR SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409435013","type":"CDM"},{"code":"00409435013","type":"NDC"}],"standard_charges":[{"gross_charge":129.39,"discounted_cash":90.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409468822","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"00409468822","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409469953","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"00409469953","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409471302","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409471302","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409475503","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00409475503","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409475518","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00409475518","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409477702","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477702","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409477702","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477702","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN 200 MG/100ML IN D5W","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409477723","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477723","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00409477750","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"00409477750","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409488710","type":"CDM"},{"code":"00409488710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409488717","type":"CDM"},{"code":"00409488717","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409488720","type":"CDM"},{"code":"00409488720","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409488724","type":"CDM"},{"code":"00409488724","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409488750","type":"CDM"},{"code":"00409488750","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409488799","type":"CDM"},{"code":"00409488799","type":"NDC"}],"standard_charges":[{"gross_charge":103.35,"discounted_cash":72.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488801","type":"CDM"},{"code":"00409488801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488802","type":"CDM"},{"code":"00409488802","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409488810","type":"CDM"},{"code":"00409488810","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409488812","type":"CDM"},{"code":"00409488812","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409488820","type":"CDM"},{"code":"00409488820","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409490234","type":"CDM"},{"code":"00409490234","type":"NDC"}],"standard_charges":[{"gross_charge":159.54,"discounted_cash":111.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409490264","type":"CDM"},{"code":"00409490264","type":"NDC"}],"standard_charges":[{"gross_charge":155.79,"discounted_cash":109.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 60 MG/3ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 200 MG/10ML (2%),LIDOCAINE HCL LOCAL IV SOLN PREF SYRINGE 100 MG/5ML (2%)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00409490334","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"00409490334","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409491134","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00409491134","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409492134","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"00409492134","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409492834","type":"CDM"},{"code":"00409492834","type":"NDC"}],"standard_charges":[{"gross_charge":248.51,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409508216","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00409508216","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409508411","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00409508411","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409508413","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00409508413","type":"NDC"}],"standard_charges":[{"gross_charge":135.24,"discounted_cash":94.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 4.2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409553434","type":"CDM"},{"code":"00409553434","type":"NDC"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOPAMINE HCL INJ 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409582001","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409582001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409592101","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00409592101","type":"NDC"}],"standard_charges":[{"gross_charge":286.04,"discounted_cash":200.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409592116","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00409592116","type":"NDC"}],"standard_charges":[{"gross_charge":178.55,"discounted_cash":124.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409592201","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00409592201","type":"NDC"}],"standard_charges":[{"gross_charge":184.12,"discounted_cash":128.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMINOPHYLLINE INJ 25 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00409592216","type":"CDM"},{"code":"J0280","type":"HCPCS"},{"code":"00409592216","type":"NDC"}],"standard_charges":[{"gross_charge":110.98,"discounted_cash":77.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610202","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610202","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610204","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610204","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610210","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610218","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610218","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610225","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610226","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610226","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00409610226","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610226","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409610236","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"00409610236","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409650901","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409650901","type":"NDC"}],"standard_charges":[{"gross_charge":1051.33,"discounted_cash":735.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409650949","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409650949","type":"NDC"}],"standard_charges":[{"gross_charge":291.44,"discounted_cash":204.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653102","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653102","type":"NDC"}],"standard_charges":[{"gross_charge":140.9,"discounted_cash":98.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653112","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653112","type":"NDC"}],"standard_charges":[{"gross_charge":108.86,"discounted_cash":76.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653301","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409653311","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"00409653311","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409662502","type":"CDM"},{"code":"00409662502","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409662514","type":"CDM"},{"code":"00409662514","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409662522","type":"CDM"},{"code":"00409662522","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx00409662530","type":"CDM"},{"code":"00409662530","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00409662902","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"00409662902","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409663734","type":"CDM"},{"code":"00409663734","type":"NDC"}],"standard_charges":[{"gross_charge":143.89,"discounted_cash":100.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00409665106","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409665106","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409669501","type":"CDM"},{"code":"00409669501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409672723","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672723","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 40 GM/1000ML (40 MG/ML)","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409672909","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672909","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409672923","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672923","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409672924","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"00409672924","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00409677802","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00409677802","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409710167","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409710167","type":"NDC"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409710169","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409710169","type":"NDC"}],"standard_charges":[{"gross_charge":146.53,"discounted_cash":102.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409710709","type":"CDM"},{"code":"00409710709","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409710909","type":"CDM"},{"code":"00409710909","type":"NDC"}],"standard_charges":[{"gross_charge":159.79,"discounted_cash":111.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN NACL 0.9% INJ,KCL 20 MEQ/L (0.149%) IN NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409711509","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409711509","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ,KCL 40 MEQ/L (0.298%) IN NACL 0.9% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409711609","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"00409711609","type":"NDC"}],"standard_charges":[{"gross_charge":161.74,"discounted_cash":113.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00409724101","type":"CDM"},{"code":"00409724101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HETASTARCH (HES /0.7 OR /0.75) 6% IN NACL 0.9% IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409724813","type":"CDM"},{"code":"00409724813","type":"NDC"}],"standard_charges":[{"gross_charge":156.86,"discounted_cash":109.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 66 MEQ/15ML (K)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00409729501","type":"CDM"},{"code":"00409729501","type":"NDC"}],"standard_charges":[{"gross_charge":169.09,"discounted_cash":118.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 66 MEQ/15ML (K)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00409729511","type":"CDM"},{"code":"00409729511","type":"NDC"}],"standard_charges":[{"gross_charge":202.48,"discounted_cash":141.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733201","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733211","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733211","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733503","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733503","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733513","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733513","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733521","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733521","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733801","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00409733811","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00409733811","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 20 MEQ/5ML (NA),SODIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 60 MEQ/15ML (NA),SODIUM PHOSPHATES INJ 150 MM/50ML (PHOS) 200 MEQ/50ML (NA)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00409739182","type":"CDM"},{"code":"00409739182","type":"NDC"}],"standard_charges":[{"gross_charge":266.4,"discounted_cash":186.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409751716","type":"CDM"},{"code":"00409751716","type":"NDC"}],"standard_charges":[{"gross_charge":177.34,"discounted_cash":124.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409751766","type":"CDM"},{"code":"00409751766","type":"NDC"}],"standard_charges":[{"gross_charge":159.01,"discounted_cash":111.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409765052","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409765052","type":"NDC"}],"standard_charges":[{"gross_charge":155.89,"discounted_cash":109.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409765062","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00409765062","type":"NDC"}],"standard_charges":[{"gross_charge":162.71,"discounted_cash":113.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOPAMINE IN DEXTROSE 5% INJ 1.6 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409780911","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409780911","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOPAMINE IN DEXTROSE 5% INJ 1.6 MG/ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409780922","type":"CDM"},{"code":"J1265","type":"HCPCS"},{"code":"00409780922","type":"NDC"}],"standard_charges":[{"gross_charge":219.87,"discounted_cash":153.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409781124","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409781124","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409781124","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"00409781124","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409790209","type":"CDM"},{"code":"00409790209","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.45% INJ","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409790409","type":"CDM"},{"code":"00409790409","type":"NDC"}],"standard_charges":[{"gross_charge":157.84,"discounted_cash":110.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792209","type":"CDM"},{"code":"J7070","type":"HCPCS"},{"code":"00409792209","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409792225","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"00409792225","type":"NDC"}],"standard_charges":[{"gross_charge":152.96,"discounted_cash":107.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.2%,DEXTROSE 5% W/ SODIUM CHLORIDE 0.225%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792409","type":"CDM"},{"code":"00409792409","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409792603","type":"CDM"},{"code":"00409792603","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792609","type":"CDM"},{"code":"00409792609","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% IN LACTATED RINGERS","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409792903","type":"CDM"},{"code":"J7121","type":"HCPCS"},{"code":"00409792903","type":"NDC"}],"standard_charges":[{"gross_charge":147.84,"discounted_cash":103.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% IN LACTATED RINGERS","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409792909","type":"CDM"},{"code":"J7121","type":"HCPCS"},{"code":"00409792909","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409793002","type":"CDM"},{"code":"00409793002","type":"NDC"}],"standard_charges":[{"gross_charge":153.45,"discounted_cash":107.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409793003","type":"CDM"},{"code":"00409793003","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409793009","type":"CDM"},{"code":"00409793009","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409794109","type":"CDM"},{"code":"J7042","type":"HCPCS"},{"code":"00409794109","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409795303","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00409795303","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTATED RINGER'S SOLUTION","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409795309","type":"CDM"},{"code":"J7120","type":"HCPCS"},{"code":"00409795309","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798302","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798302","type":"NDC"}],"standard_charges":[{"gross_charge":153.45,"discounted_cash":107.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409798303","type":"CDM"},{"code":"J7040","type":"HCPCS"},{"code":"00409798303","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409798309","type":"CDM"},{"code":"J7030","type":"HCPCS"},{"code":"00409798309","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx00409798361","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798361","type":"NDC"}],"standard_charges":[{"gross_charge":153.25,"discounted_cash":107.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx00409798406","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798406","type":"NDC"}],"standard_charges":[{"gross_charge":189.52,"discounted_cash":132.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409798413","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798413","type":"NDC"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00409798423","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798423","type":"NDC"}],"standard_charges":[{"gross_charge":147.7,"discounted_cash":103.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00409798436","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00409798436","type":"NDC"}],"standard_charges":[{"gross_charge":146.53,"discounted_cash":102.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx00409798503","type":"CDM"},{"code":"00409798503","type":"NDC"}],"standard_charges":[{"gross_charge":154.91,"discounted_cash":108.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.45%","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"Rx00409798509","type":"CDM"},{"code":"00409798509","type":"NDC"}],"standard_charges":[{"gross_charge":153.94,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904201","type":"CDM"},{"code":"00409904201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904211","type":"CDM"},{"code":"00409904211","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904501","type":"CDM"},{"code":"00409904501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904511","type":"CDM"},{"code":"00409904511","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00409904517","type":"CDM"},{"code":"00409904517","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409909332","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909332","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409909335","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909335","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409909337","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909337","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00409909345","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909345","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909412","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909412","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909422","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909422","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409909425","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00409909425","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409915801","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00409915825","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"00409915825","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 20 MG/2ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 75 MG/7.5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409955805","type":"CDM"},{"code":"00409955805","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00409955849","type":"CDM"},{"code":"00409955849","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.125%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00436067216","type":"CDM"},{"code":"00436067216","type":"NDC"}],"standard_charges":[{"gross_charge":17.97,"discounted_cash":12.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.25%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx00436093616","type":"CDM"},{"code":"00436093616","type":"NDC"}],"standard_charges":[{"gross_charge":17.97,"discounted_cash":12.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00440767690","type":"CDM"},{"code":"00440767690","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 240 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00440861030","type":"CDM"},{"code":"00440861030","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THYROID TAB 60 MG (1 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456045901","type":"CDM"},{"code":"00456045901","type":"NDC"}],"standard_charges":[{"gross_charge":12.04,"discounted_cash":8.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME-AVIBACTAM SODIUM FOR IV SOLN 2.5 GM (2-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456270001","type":"CDM"},{"code":"J0714","type":"HCPCS"},{"code":"00456270001","type":"NDC"}],"standard_charges":[{"gross_charge":1475.68,"discounted_cash":1032.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME-AVIBACTAM SODIUM FOR IV SOLN 2.5 GM (2-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456270010","type":"CDM"},{"code":"J0714","type":"HCPCS"},{"code":"00456270010","type":"NDC"}],"standard_charges":[{"gross_charge":1476.16,"discounted_cash":1033.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456320511","type":"CDM"},{"code":"00456320511","type":"NDC"}],"standard_charges":[{"gross_charge":22.96,"discounted_cash":16.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456320560","type":"CDM"},{"code":"00456320560","type":"NDC"}],"standard_charges":[{"gross_charge":22.92,"discounted_cash":16.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEMANTINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456320563","type":"CDM"},{"code":"00456320563","type":"NDC"}],"standard_charges":[{"gross_charge":22.83,"discounted_cash":15.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00456321011","type":"CDM"},{"code":"00456321011","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIRABEGRON TAB ER 24 HR 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00469260130","type":"CDM"},{"code":"00469260130","type":"NDC"}],"standard_charges":[{"gross_charge":36.42,"discounted_cash":25.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"REGADENOSON IV INJ 0.4 MG/5ML (0.08 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00469650189","type":"CDM"},{"code":"J2785","type":"HCPCS"},{"code":"00469650189","type":"NDC"}],"standard_charges":[{"gross_charge":964.26,"discounted_cash":674.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00472016615","type":"CDM"},{"code":"00472016615","type":"NDC"}],"standard_charges":[{"gross_charge":87.98,"discounted_cash":61.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PERMETHRIN CREAM 5%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx00472024260","type":"CDM"},{"code":"00472024260","type":"NDC"}],"standard_charges":[{"gross_charge":311.76,"discounted_cash":218.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx00472032126","type":"CDM"},{"code":"00472032126","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":3.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00472034356","type":"CDM"},{"code":"00472034356","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00472037915","type":"CDM"},{"code":"00472037915","type":"NDC"}],"standard_charges":[{"gross_charge":77.57,"discounted_cash":54.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICONAZOLE NITRATE CREAM 2%","drug_information":{"unit":14.0,"type":"GM"},"code_information":[{"code":"Rx00472073514","type":"CDM"},{"code":"00472073514","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICONAZOLE NITRATE CREAM 2%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx00472073542","type":"CDM"},{"code":"00472073542","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00472110556","type":"CDM"},{"code":"00472110556","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487020101","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"00487020101","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RACEPINEPHRINE HCL SOLN NEBU 2.25% (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00487590199","type":"CDM"},{"code":"00487590199","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00487901060","type":"CDM"},{"code":"00487901060","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE SOLN NEBU 0.9%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00487930133","type":"CDM"},{"code":"00487930133","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx00487950101","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"00487950101","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00487970101","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"00487970101","type":"NDC"}],"standard_charges":[{"gross_charge":18.15,"discounted_cash":12.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00487980100","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"00487980100","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00487980101","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"00487980101","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00487980130","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"00487980130","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517003125","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"00517003125","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE INJ 0.4 MG/ML,ATROPINE SULFATE IV SOLN 0.4 MG/ML,ATROPINE SULFATE INJ PF 0.4 MG/ML,ATROPINE SULFATE IV SOLN PREFILLED SYRINGE 0.4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00517040125","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00517040125","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FERRIC CARBOXYMALTOSE IV SOLN 750 MG/15ML (FE EQUIVALENT)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00517065001","type":"CDM"},{"code":"J1439","type":"HCPCS"},{"code":"00517065001","type":"NDC"}],"standard_charges":[{"gross_charge":4163.13,"discounted_cash":2914.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517072001","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"00517072001","type":"NDC"}],"standard_charges":[{"gross_charge":111.39,"discounted_cash":77.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517079101","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"00517079101","type":"NDC"}],"standard_charges":[{"gross_charge":111.39,"discounted_cash":77.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00517095501","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"00517095501","type":"NDC"}],"standard_charges":[{"gross_charge":575.42,"discounted_cash":402.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE INJ 0.4 MG/ML,ATROPINE SULFATE IV SOLN 0.4 MG/ML,ATROPINE SULFATE INJ PF 0.4 MG/ML,ATROPINE SULFATE IV SOLN PREFILLED SYRINGE 0.4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00517100401","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"00517100401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE INJ 0.4 MG/ML,ATROPINE SULFATE IV SOLN 0.4 MG/ML,ATROPINE SULFATE INJ PF 0.4 MG/ML,ATROPINE SULFATE IV SOLN PREFILLED SYRINGE 0.4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00517100425","type":"CDM"},{"code":"J0462","type":"HCPCS"},{"code":"00517100425","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE INJ 1 MG/ML,ATROPINE SULFATE IV SOLN 1 MG/ML,ATROPINE SULFATE INJ PF 1 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00517101025","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00517101025","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517231001","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517231001","type":"NDC"}],"standard_charges":[{"gross_charge":235.87,"discounted_cash":165.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517231005","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517231005","type":"NDC"}],"standard_charges":[{"gross_charge":167.66,"discounted_cash":117.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517234001","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517234001","type":"NDC"}],"standard_charges":[{"gross_charge":167.66,"discounted_cash":117.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IRON SUCROSE INJ 20 MG/ML (FE EQUIV)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00517234010","type":"CDM"},{"code":"J1756","type":"HCPCS"},{"code":"00517234010","type":"NDC"}],"standard_charges":[{"gross_charge":167.66,"discounted_cash":117.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE HCL IM SOLN 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517420101","type":"CDM"},{"code":"J3410","type":"HCPCS"},{"code":"00517420101","type":"NDC"}],"standard_charges":[{"gross_charge":244.98,"discounted_cash":171.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE HCL IM SOLN 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517420125","type":"CDM"},{"code":"J3410","type":"HCPCS"},{"code":"00517420125","type":"NDC"}],"standard_charges":[{"gross_charge":267.51,"discounted_cash":187.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00517460125","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00517460125","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00517460225","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"00517460225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROGLYCERIN IV SOLN 5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00517481025","type":"CDM"},{"code":"J2305","type":"HCPCS"},{"code":"00517481025","type":"NDC"}],"standard_charges":[{"gross_charge":192.86,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 10%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517751003","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00517751003","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":9.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00517760401","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00517760401","type":"NDC"}],"standard_charges":[{"gross_charge":12.21,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 20%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx00517760425","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"00517760425","type":"NDC"}],"standard_charges":[{"gross_charge":19.55,"discounted_cash":13.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DROPERIDOL INJ 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517970201","type":"CDM"},{"code":"J1790","type":"HCPCS"},{"code":"00517970201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DROPERIDOL INJ 2.5 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00517970225","type":"CDM"},{"code":"J1790","type":"HCPCS"},{"code":"00517970225","type":"NDC"}],"standard_charges":[{"gross_charge":115.46,"discounted_cash":80.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527105001","type":"CDM"},{"code":"00527105001","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527134601","type":"CDM"},{"code":"00527134601","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527141901","type":"CDM"},{"code":"00527141901","type":"NDC"}],"standard_charges":[{"gross_charge":16.04,"discounted_cash":11.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527163201","type":"CDM"},{"code":"00527163201","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL CONC 10 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00527192736","type":"CDM"},{"code":"00527192736","type":"NDC"}],"standard_charges":[{"gross_charge":46.32,"discounted_cash":32.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00527411737","type":"CDM"},{"code":"00527411737","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00527600480","type":"CDM"},{"code":"00527600480","type":"NDC"}],"standard_charges":[{"gross_charge":112.84,"discounted_cash":78.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALUMINUM HYDROXIDE GEL SUSP 320 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00536009185","type":"CDM"},{"code":"00536009185","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM CARBONATE (ANTACID) CHEW TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536100715","type":"CDM"},{"code":"00536100715","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536100836","type":"CDM"},{"code":"00536100836","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536110688","type":"CDM"},{"code":"00536110688","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536110788","type":"CDM"},{"code":"00536110788","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536110888","type":"CDM"},{"code":"00536110888","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL CREAM 4%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00536113920","type":"CDM"},{"code":"00536113920","type":"NDC"}],"standard_charges":[{"gross_charge":8.38,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536117201","type":"CDM"},{"code":"00536117201","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00536118297","type":"CDM"},{"code":"00536118297","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx00536118497","type":"CDM"},{"code":"00536118497","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOL LIQUID 1.4%","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx00536122858","type":"CDM"},{"code":"00536122858","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536123201","type":"CDM"},{"code":"00536123201","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536123441","type":"CDM"},{"code":"00536123441","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOTIFEN FUMARATE OPHTH SOLN 0.035%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00536125240","type":"CDM"},{"code":"00536125240","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE HYPERTONIC OPHTH SOLN 5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00536125494","type":"CDM"},{"code":"00536125494","type":"NDC"}],"standard_charges":[{"gross_charge":3.91,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00536126328","type":"CDM"},{"code":"00536126328","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00536127780","type":"CDM"},{"code":"00536127780","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BISMUTH SUBSALICYLATE SUSP 262 MG/15ML","drug_information":{"unit":237.0,"type":"ML"},"code_information":[{"code":"Rx00536128636","type":"CDM"},{"code":"00536128636","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx00536129497","type":"CDM"},{"code":"00536129497","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536129801","type":"CDM"},{"code":"00536129801","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZINC OXIDE OINT 20%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00536131628","type":"CDM"},{"code":"00536131628","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYVINYL ALCOHOL OPHTH SOLN 1.4%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00536132594","type":"CDM"},{"code":"00536132594","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536132701","type":"CDM"},{"code":"00536132701","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536136234","type":"CDM"},{"code":"00536136234","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536137234","type":"CDM"},{"code":"00536137234","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICONAZOLE NITRATE CREAM 2%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00536137575","type":"CDM"},{"code":"00536137575","type":"NDC"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00536138635","type":"CDM"},{"code":"00536138635","type":"NDC"}],"standard_charges":[{"gross_charge":4.69,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00536138694","type":"CDM"},{"code":"00536138694","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":4.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00536140795","type":"CDM"},{"code":"00536140795","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYVINYL ALCOHOL OPHTH SOLN 1.4%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00536140894","type":"CDM"},{"code":"00536140894","type":"NDC"}],"standard_charges":[{"gross_charge":5.43,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"B-COMPLEX VITAMIN TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536141401","type":"CDM"},{"code":"00536141401","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00536143097","type":"CDM"},{"code":"00536143097","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536302934","type":"CDM"},{"code":"00536302934","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536333401","type":"CDM"},{"code":"00536333401","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536344238","type":"CDM"},{"code":"00536344238","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM POLYCARBOPHIL TAB 625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536430608","type":"CDM"},{"code":"00536430608","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PYRIDOXINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536440901","type":"CDM"},{"code":"00536440901","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"B-COMPLEX VITAMIN CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536478701","type":"CDM"},{"code":"00536478701","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZINC OXIDE OINT 20%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx00536570028","type":"CDM"},{"code":"00536570028","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536589488","type":"CDM"},{"code":"00536589488","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536589588","type":"CDM"},{"code":"00536589588","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536589688","type":"CDM"},{"code":"00536589688","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OMEGA-3 FATTY ACIDS CAP 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00536718706","type":"CDM"},{"code":"00536718706","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00548540000","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"00548540000","type":"NDC"}],"standard_charges":[{"gross_charge":391.29,"discounted_cash":273.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"COSYNTROPIN FOR INJ 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00548590000","type":"CDM"},{"code":"J0834","type":"HCPCS"},{"code":"00548590000","type":"NDC"}],"standard_charges":[{"gross_charge":291.57,"discounted_cash":204.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555015902","type":"CDM"},{"code":"00555015902","type":"NDC"}],"standard_charges":[{"gross_charge":11.84,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555087202","type":"CDM"},{"code":"00555087202","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESTRADIOL TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555088602","type":"CDM"},{"code":"00555088602","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00555100901","type":"CDM"},{"code":"00555100901","type":"NDC"}],"standard_charges":[{"gross_charge":36.11,"discounted_cash":25.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00562780500","type":"CDM"},{"code":"J2790","type":"HCPCS"},{"code":"00562780500","type":"NDC"}],"standard_charges":[{"gross_charge":1042.54,"discounted_cash":729.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00562780501","type":"CDM"},{"code":"J2790","type":"HCPCS"},{"code":"00562780501","type":"NDC"}],"standard_charges":[{"gross_charge":1042.54,"discounted_cash":729.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00562780505","type":"CDM"},{"code":"J2790","type":"HCPCS"},{"code":"00562780505","type":"NDC"}],"standard_charges":[{"gross_charge":1042.59,"discounted_cash":729.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574006915","type":"CDM"},{"code":"00574006915","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574006930","type":"CDM"},{"code":"00574006930","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLUCOSE GEL 40%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00574007015","type":"CDM"},{"code":"00574007015","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574012108","type":"CDM"},{"code":"00574012108","type":"NDC"}],"standard_charges":[{"gross_charge":8.16,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":240.0,"type":"ML"},"code_information":[{"code":"Rx00574012176","type":"CDM"},{"code":"00574012176","type":"NDC"}],"standard_charges":[{"gross_charge":17.04,"discounted_cash":11.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574052108","type":"CDM"},{"code":"00574052108","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx00574052176","type":"CDM"},{"code":"00574052176","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00574080530","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"00574080530","type":"NDC"}],"standard_charges":[{"gross_charge":559.52,"discounted_cash":391.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00574081530","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"00574081530","type":"NDC"}],"standard_charges":[{"gross_charge":2246.71,"discounted_cash":1572.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00574085005","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"00574085005","type":"NDC"}],"standard_charges":[{"gross_charge":1557.05,"discounted_cash":1089.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx00574402450","type":"CDM"},{"code":"00574402450","type":"NDC"}],"standard_charges":[{"gross_charge":69.67,"discounted_cash":48.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00574416035","type":"CDM"},{"code":"00574416035","type":"NDC"}],"standard_charges":[{"gross_charge":84.35,"discounted_cash":59.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN SUPPOS 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574703412","type":"CDM"},{"code":"00574703412","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BISACODYL SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574705012","type":"CDM"},{"code":"00574705012","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00574722612","type":"CDM"},{"code":"00574722612","type":"NDC"}],"standard_charges":[{"gross_charge":24.04,"discounted_cash":16.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00591014926","type":"CDM"},{"code":"J2916","type":"HCPCS"},{"code":"00591014926","type":"NDC"}],"standard_charges":[{"gross_charge":206.3,"discounted_cash":144.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591024101","type":"CDM"},{"code":"00591024101","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591034301","type":"CDM"},{"code":"00591034301","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591040401","type":"CDM"},{"code":"00591040401","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591042401","type":"CDM"},{"code":"00591042401","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591079601","type":"CDM"},{"code":"00591079601","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591267911","type":"CDM"},{"code":"00591267911","type":"NDC"}],"standard_charges":[{"gross_charge":22.91,"discounted_cash":16.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591267930","type":"CDM"},{"code":"00591267930","type":"NDC"}],"standard_charges":[{"gross_charge":12.65,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVALBUTEROL TARTRATE INHAL AEROSOL 45 MCG/ACT (BASE EQUIV)","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00591292754","type":"CDM"},{"code":"00591292754","type":"NDC"}],"standard_charges":[{"gross_charge":196.5,"discounted_cash":137.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591304101","type":"CDM"},{"code":"00591304101","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591352511","type":"CDM"},{"code":"00591352511","type":"NDC"}],"standard_charges":[{"gross_charge":13.14,"discounted_cash":9.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591352530","type":"CDM"},{"code":"00591352530","type":"NDC"}],"standard_charges":[{"gross_charge":12.63,"discounted_cash":8.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL (SMOKING DETERRENT) TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591354376","type":"CDM"},{"code":"00591354376","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591387544","type":"CDM"},{"code":"00591387544","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591387545","type":"CDM"},{"code":"00591387545","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591493001","type":"CDM"},{"code":"00591493001","type":"NDC"}],"standard_charges":[{"gross_charge":11.52,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00591555501","type":"CDM"},{"code":"00591555501","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597000160","type":"CDM"},{"code":"00597000160","type":"NDC"}],"standard_charges":[{"gross_charge":26.36,"discounted_cash":18.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597003134","type":"CDM"},{"code":"00597003134","type":"NDC"}],"standard_charges":[{"gross_charge":135.48,"discounted_cash":94.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TIOTROPIUM BROMIDE INHAL AEROSOL 2.5 MCG/ACT","drug_information":{"unit":4.0,"type":"GM"},"code_information":[{"code":"Rx00597010051","type":"CDM"},{"code":"00597010051","type":"NDC"}],"standard_charges":[{"gross_charge":116.49,"discounted_cash":81.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EMPAGLIFLOZIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597015237","type":"CDM"},{"code":"00597015237","type":"NDC"}],"standard_charges":[{"gross_charge":27.26,"discounted_cash":19.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EMPAGLIFLOZIN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597015290","type":"CDM"},{"code":"00597015290","type":"NDC"}],"standard_charges":[{"gross_charge":27.26,"discounted_cash":19.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IDARUCIZUMAB IV SOLN 2.5 GM/50ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00597019705","type":"CDM"},{"code":"J3590","type":"HCPCS"},{"code":"00597019705","type":"NDC"}],"standard_charges":[{"gross_charge":20713.75,"discounted_cash":14499.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 75 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597035556","type":"CDM"},{"code":"00597035556","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 150 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597036055","type":"CDM"},{"code":"00597036055","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE CAP 150 MG (ETEXILATE BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00597036082","type":"CDM"},{"code":"00597036082","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603015021","type":"CDM"},{"code":"00603015021","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%,LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00603139447","type":"CDM"},{"code":"00603139447","type":"NDC"}],"standard_charges":[{"gross_charge":60.57,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603155404","type":"CDM"},{"code":"00603155404","type":"NDC"}],"standard_charges":[{"gross_charge":22.66,"discounted_cash":15.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603155410","type":"CDM"},{"code":"00603155410","type":"NDC"}],"standard_charges":[{"gross_charge":22.61,"discounted_cash":15.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603155416","type":"CDM"},{"code":"00603155416","type":"NDC"}],"standard_charges":[{"gross_charge":23.32,"discounted_cash":16.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603188010","type":"CDM"},{"code":"00603188010","type":"NDC"}],"standard_charges":[{"gross_charge":13.42,"discounted_cash":9.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603188016","type":"CDM"},{"code":"00603188016","type":"NDC"}],"standard_charges":[{"gross_charge":13.72,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603211521","type":"CDM"},{"code":"00603211521","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603243421","type":"CDM"},{"code":"00603243421","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603243821","type":"CDM"},{"code":"00603243821","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603411021","type":"CDM"},{"code":"00603411021","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603459321","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"00603459321","type":"NDC"}],"standard_charges":[{"gross_charge":12.07,"discounted_cash":8.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00603533521","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00603533521","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641036721","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641036721","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641036721","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641036721","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":8.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML,DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML,DEXAMETHASONE SOD PHOS INJ SOL PREF SYR 10 MG/ML (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641036725","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641036725","type":"NDC"}],"standard_charges":[{"gross_charge":11.51,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML,DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML,DEXAMETHASONE SOD PHOS INJ SOL PREF SYR 10 MG/ML (PF)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641036725","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"00641036725","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641037621","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"00641037621","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641037625","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"00641037625","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641040012","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00641040012","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641047621","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"00641047621","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641047625","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"00641047625","type":"NDC"}],"standard_charges":[{"gross_charge":206.56,"discounted_cash":144.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641139731","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"00641139731","type":"NDC"}],"standard_charges":[{"gross_charge":343.82,"discounted_cash":240.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641139735","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"00641139735","type":"NDC"}],"standard_charges":[{"gross_charge":400.1,"discounted_cash":280.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 50 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641139831","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"00641139831","type":"NDC"}],"standard_charges":[{"gross_charge":109.99,"discounted_cash":76.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 50 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641139835","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"00641139835","type":"NDC"}],"standard_charges":[{"gross_charge":331.26,"discounted_cash":231.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641141031","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"00641141031","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641141035","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"00641141035","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPYRIDAMOLE IV SOLN 5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641256941","type":"CDM"},{"code":"J1245","type":"HCPCS"},{"code":"00641256941","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPYRIDAMOLE IV SOLN 5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641256944","type":"CDM"},{"code":"J1245","type":"HCPCS"},{"code":"00641256944","type":"NDC"}],"standard_charges":[{"gross_charge":268.71,"discounted_cash":188.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641600101","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641600101","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641600125","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641600125","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE INJ 8 MG/20ML (0.4 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641600601","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00641600601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641600701","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00641600701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641600710","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"00641600710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641601301","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641601301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00641601310","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"00641601310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641601501","type":"CDM"},{"code":"00641601501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641601510","type":"CDM"},{"code":"00641601510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 0.5 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641602010","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00641602010","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641602201","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"00641602201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641602225","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"00641602225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641602701","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641602701","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641602725","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"00641602725","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULF FOR MICROINFUSION PF INJ 200 MG/20ML (10MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx00641603901","type":"CDM"},{"code":"J2274","type":"HCPCS"},{"code":"00641603901","type":"NDC"}],"standard_charges":[{"gross_charge":2367.55,"discounted_cash":1657.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604401","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604401","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604425","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604425","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604801","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604801","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641604825","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"00641604825","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641605201","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00641605201","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEPERIDINE HCL INJ 25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641605225","type":"CDM"},{"code":"J2175","type":"HCPCS"},{"code":"00641605225","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641605601","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641605601","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641605610","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641605610","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641605701","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641605701","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641605710","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641605710","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641606001","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606001","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641606010","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606010","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx00641606101","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606101","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641606101","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606101","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641606125","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606125","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00641606125","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641606125","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641607801","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00641607801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641607825","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00641607825","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641608001","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00641608001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00641608025","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"00641608025","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUFENTANIL CITRATE INJ 100 MCG/2ML (50 MCG/ML)","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx00641611101","type":"CDM"},{"code":"00641611101","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUFENTANIL CITRATE INJ 100 MCG/2ML (50 MCG/ML)","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx00641611110","type":"CDM"},{"code":"00641611110","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611601","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611701","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00641611710","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"00641611710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00641612501","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641612501","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx00641612525","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"00641612525","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641613201","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00641613201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx00641613225","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00641613225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":0.006,"type":"ML"},"code_information":[{"code":"Rx00641614201","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00641614201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641614225","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00641614225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":0.006,"type":"ML"},"code_information":[{"code":"Rx00641614225","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"00641614225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641614901","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"00641614901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00641614910","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"00641614910","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641617501","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00641617501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00641617510","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00641617510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00641620501","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00641620501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00641620510","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"00641620510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE INJ 8 MG/20ML (0.4 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641625101","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00641625101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE INJ 8 MG/20ML (0.4 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641625110","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"00641625110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641628101","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641628101","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00641628125","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"00641628125","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00703005101","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"00703005101","type":"NDC"}],"standard_charges":[{"gross_charge":208.44,"discounted_cash":145.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00703011303","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"00703011303","type":"NDC"}],"standard_charges":[{"gross_charge":117.42,"discounted_cash":82.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00703012501","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"00703012501","type":"NDC"}],"standard_charges":[{"gross_charge":266.8,"discounted_cash":186.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00703024101","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"00703024101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 200 MCG/ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00703333301","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"00703333301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703450201","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00703450201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00703450204","type":"CDM"},{"code":"J2765","type":"HCPCS"},{"code":"00703450204","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00703854021","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00703854021","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00703854023","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00703854023","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BISACODYL SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713010906","type":"CDM"},{"code":"00713010906","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713011806","type":"CDM"},{"code":"00713011806","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713013506","type":"CDM"},{"code":"00713013506","type":"NDC"}],"standard_charges":[{"gross_charge":20.67,"discounted_cash":14.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713013512","type":"CDM"},{"code":"00713013512","type":"NDC"}],"standard_charges":[{"gross_charge":25.05,"discounted_cash":17.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx00713026831","type":"CDM"},{"code":"00713026831","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACITRACIN OINT 500 UNIT/GM","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx00713028031","type":"CDM"},{"code":"00713028031","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00713035102","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"00713035102","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00713035125","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"00713035125","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713050312","type":"CDM"},{"code":"00713050312","type":"NDC"}],"standard_charges":[{"gross_charge":29.83,"discounted_cash":20.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROMETHAZINE HCL SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00713052612","type":"CDM"},{"code":"00713052612","type":"NDC"}],"standard_charges":[{"gross_charge":16.15,"discounted_cash":11.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN OINT 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx00713068615","type":"CDM"},{"code":"00713068615","type":"NDC"}],"standard_charges":[{"gross_charge":58.69,"discounted_cash":41.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZINC SULFATE CAP 220 MG (50 MG ELEMENTAL ZN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00731040106","type":"CDM"},{"code":"00731040106","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00761035920","type":"CDM"},{"code":"00761035920","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781120501","type":"CDM"},{"code":"00781120501","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781139113","type":"CDM"},{"code":"00781139113","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781139613","type":"CDM"},{"code":"00781139613","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781155601","type":"CDM"},{"code":"00781155601","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ISOSORBIDE DINITRATE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781155613","type":"CDM"},{"code":"00781155613","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMIPRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781176413","type":"CDM"},{"code":"00781176413","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 250-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781187431","type":"CDM"},{"code":"00781187431","type":"NDC"}],"standard_charges":[{"gross_charge":13.32,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLARITHROMYCIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781196260","type":"CDM"},{"code":"00781196260","type":"NDC"}],"standard_charges":[{"gross_charge":11.79,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781202001","type":"CDM"},{"code":"00781202001","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781217660","type":"CDM"},{"code":"00781217660","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICLOXACILLIN SODIUM CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781224801","type":"CDM"},{"code":"00781224801","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781261301","type":"CDM"},{"code":"00781261301","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781300094","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00781300094","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781300095","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00781300095","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781305972","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"00781305972","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIGOXIN INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781305995","type":"CDM"},{"code":"J1160","type":"HCPCS"},{"code":"00781305995","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781309894","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00781309894","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781309895","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"00781309895","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781311090","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781311090","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781311390","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781311390","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781311395","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781311395","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781311491","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781311491","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781311495","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781311495","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CISATRACURIUM BESYLATE (PF) IV SOLN 10 MG/5ML (2 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00781315095","type":"CDM"},{"code":"00781315095","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FERUMOXYTOL INJ 510 MG/17ML (30 MG/ML) (ELEMENTAL FE)","drug_information":{"unit":17.0,"type":"ML"},"code_information":[{"code":"Rx00781315401","type":"CDM"},{"code":"Q0138","type":"HCPCS"},{"code":"00781315401","type":"NDC"}],"standard_charges":[{"gross_charge":2037.85,"discounted_cash":1426.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781315972","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"00781315972","type":"NDC"}],"standard_charges":[{"gross_charge":232.93,"discounted_cash":163.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781317780","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00781317780","type":"NDC"}],"standard_charges":[{"gross_charge":166.36,"discounted_cash":116.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781317796","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"00781317796","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320785","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320785","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320885","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320885","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320895","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320895","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320990","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320990","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781320995","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781320995","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781322402","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781322402","type":"NDC"}],"standard_charges":[{"gross_charge":260.58,"discounted_cash":182.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781322464","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781322464","type":"NDC"}],"standard_charges":[{"gross_charge":260.58,"discounted_cash":182.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781323294","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"00781323294","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00781323801","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781323801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00781323863","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781323863","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781324602","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781324602","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00781324664","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781324664","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00781325603","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781325603","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00781325666","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781325666","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00781326204","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781326204","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00781326268","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781326268","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00781326805","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781326805","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00781326869","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781326869","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781328909","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781328909","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781328991","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781328991","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781329009","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781329009","type":"NDC"}],"standard_charges":[{"gross_charge":148.12,"discounted_cash":103.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781329091","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781329091","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx00781329804","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781329804","type":"NDC"}],"standard_charges":[{"gross_charge":147.91,"discounted_cash":103.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx00781329868","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781329868","type":"NDC"}],"standard_charges":[{"gross_charge":116.26,"discounted_cash":81.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx00781329905","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781329905","type":"NDC"}],"standard_charges":[{"gross_charge":146.81,"discounted_cash":102.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx00781329969","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781329969","type":"NDC"}],"standard_charges":[{"gross_charge":151.62,"discounted_cash":106.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781334496","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781334496","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781336794","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781336794","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781336795","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781336795","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340485","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340485","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340495","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340495","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340880","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340880","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781340895","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781340895","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx00781341170","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"00781341170","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"COSYNTROPIN FOR INJ 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781344071","type":"CDM"},{"code":"J0834","type":"HCPCS"},{"code":"00781344071","type":"NDC"}],"standard_charges":[{"gross_charge":259.98,"discounted_cash":181.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781345070","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"00781345070","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TIGECYCLINE FOR IV SOLN 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781348192","type":"CDM"},{"code":"J3243","type":"HCPCS"},{"code":"00781348192","type":"NDC"}],"standard_charges":[{"gross_charge":202.45,"discounted_cash":141.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00781350005","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00781350005","type":"NDC"}],"standard_charges":[{"gross_charge":143.9,"discounted_cash":100.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx00781354010","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"00781354010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781523806","type":"CDM"},{"code":"00781523806","type":"NDC"}],"standard_charges":[{"gross_charge":11.22,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781523864","type":"CDM"},{"code":"00781523864","type":"NDC"}],"standard_charges":[{"gross_charge":11.23,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781531008","type":"CDM"},{"code":"00781531008","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781531106","type":"CDM"},{"code":"00781531106","type":"NDC"}],"standard_charges":[{"gross_charge":13.31,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RISPERIDONE ORALLY DISINTEGRATING TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781531108","type":"CDM"},{"code":"00781531108","type":"NDC"}],"standard_charges":[{"gross_charge":17.99,"discounted_cash":12.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781531701","type":"CDM"},{"code":"00781531701","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781569031","type":"CDM"},{"code":"00781569031","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781570192","type":"CDM"},{"code":"00781570192","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781574801","type":"CDM"},{"code":"00781574801","type":"NDC"}],"standard_charges":[{"gross_charge":12.56,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781591401","type":"CDM"},{"code":"00781591401","type":"NDC"}],"standard_charges":[{"gross_charge":16.59,"discounted_cash":11.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781604158","type":"CDM"},{"code":"00781604158","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00781613957","type":"CDM"},{"code":"00781613957","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE VAGINAL GEL 0.75%","drug_information":{"unit":70.0,"type":"GM"},"code_information":[{"code":"Rx00781707787","type":"CDM"},{"code":"00781707787","type":"NDC"}],"standard_charges":[{"gross_charge":373.65,"discounted_cash":261.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781721606","type":"CDM"},{"code":"00781721606","type":"NDC"}],"standard_charges":[{"gross_charge":15.03,"discounted_cash":10.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781721664","type":"CDM"},{"code":"00781721664","type":"NDC"}],"standard_charges":[{"gross_charge":18.61,"discounted_cash":13.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781723806","type":"CDM"},{"code":"00781723806","type":"NDC"}],"standard_charges":[{"gross_charge":16.86,"discounted_cash":11.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781723864","type":"CDM"},{"code":"00781723864","type":"NDC"}],"standard_charges":[{"gross_charge":24.21,"discounted_cash":16.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781724055","type":"CDM"},{"code":"00781724055","type":"NDC"}],"standard_charges":[{"gross_charge":39.81,"discounted_cash":27.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":6.7,"type":"GM"},"code_information":[{"code":"Rx00781729685","type":"CDM"},{"code":"00781729685","type":"NDC"}],"standard_charges":[{"gross_charge":145.5,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781808931","type":"CDM"},{"code":"00781808931","type":"NDC"}],"standard_charges":[{"gross_charge":13.83,"discounted_cash":9.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781912595","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"00781912595","type":"NDC"}],"standard_charges":[{"gross_charge":195.14,"discounted_cash":136.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781921390","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781921390","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781921395","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781921395","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781921491","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"00781921491","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781922191","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781922191","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00781922291","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"00781922291","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781926195","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781926195","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781932885","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781932885","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781932895","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"00781932895","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781940485","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781940485","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781940495","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781940495","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781940880","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781940880","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00781940895","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"00781940895","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832003800","type":"CDM"},{"code":"00832003800","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832003801","type":"CDM"},{"code":"00832003801","type":"NDC"}],"standard_charges":[{"gross_charge":10.91,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832003889","type":"CDM"},{"code":"00832003889","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORPROMAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832030100","type":"CDM"},{"code":"00832030100","type":"NDC"}],"standard_charges":[{"gross_charge":13.06,"discounted_cash":9.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832101500","type":"CDM"},{"code":"00832101500","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":8.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121189","type":"CDM"},{"code":"00832121189","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121201","type":"CDM"},{"code":"00832121201","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121289","type":"CDM"},{"code":"00832121289","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121389","type":"CDM"},{"code":"00832121389","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121401","type":"CDM"},{"code":"00832121401","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121489","type":"CDM"},{"code":"00832121489","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832121689","type":"CDM"},{"code":"00832121689","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832532411","type":"CDM"},{"code":"00832532411","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00832605311","type":"CDM"},{"code":"00832605311","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE ORAL GRANULES","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx00869060243","type":"CDM"},{"code":"00869060243","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904020161","type":"CDM"},{"code":"00904020161","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904042806","type":"CDM"},{"code":"00904042806","type":"NDC"}],"standard_charges":[{"gross_charge":12.37,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904043004","type":"CDM"},{"code":"00904043004","type":"NDC"}],"standard_charges":[{"gross_charge":12.85,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904043006","type":"CDM"},{"code":"00904043006","type":"NDC"}],"standard_charges":[{"gross_charge":12.81,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASCORBIC ACID TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904052361","type":"CDM"},{"code":"00904052361","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MULTIPLE VITAMIN TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904053961","type":"CDM"},{"code":"00904053961","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904054460","type":"CDM"},{"code":"00904054460","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00904073431","type":"CDM"},{"code":"00904073431","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BISMUTH SUBSALICYLATE SUSP 262 MG/15ML","drug_information":{"unit":236.0,"type":"ML"},"code_information":[{"code":"Rx00904131309","type":"CDM"},{"code":"00904131309","type":"NDC"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904145361","type":"CDM"},{"code":"00904145361","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904198260","type":"CDM"},{"code":"00904198260","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904198261","type":"CDM"},{"code":"00904198261","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904198861","type":"CDM"},{"code":"00904198861","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FERROUS GLUCONATE TAB 324 MG (37.5 MG ELEMENTAL IRON)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904213761","type":"CDM"},{"code":"00904213761","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM POLYCARBOPHIL TAB 625 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904250091","type":"CDM"},{"code":"00904250091","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904272561","type":"CDM"},{"code":"00904272561","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904282161","type":"CDM"},{"code":"00904282161","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904292061","type":"CDM"},{"code":"00904292061","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEGESTROL ACETATE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904357161","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"00904357161","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SALINE NASAL SPRAY 0.65%","drug_information":{"unit":44.0,"type":"ML"},"code_information":[{"code":"Rx00904386575","type":"CDM"},{"code":"00904386575","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SALINE NASAL SPRAY 0.65%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx00904386575","type":"CDM"},{"code":"00904386575","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904404073","type":"CDM"},{"code":"00904404073","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"B-COMPLEX VITAMIN TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904418160","type":"CDM"},{"code":"00904418160","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM OXIDE TAB 500 MG (MG SUPPLEMENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904423960","type":"CDM"},{"code":"00904423960","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PSEUDOEPHEDRINE HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904505359","type":"CDM"},{"code":"00904505359","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PSEUDOEPHEDRINE HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904505360","type":"CDM"},{"code":"00904505360","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904506860","type":"CDM"},{"code":"00904506860","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904528261","type":"CDM"},{"code":"00904528261","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904530661","type":"CDM"},{"code":"Q0163","type":"HCPCS"},{"code":"00904530661","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRENATAL VIT W/ FE FUMARATE-FA TAB 27-0.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904531346","type":"CDM"},{"code":"00904531346","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRENATAL VIT W/ FE FUMARATE-FA TAB 27-0.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904531360","type":"CDM"},{"code":"00904531360","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRENATAL VIT W/ FE FUMARATE-FA TAB 27-0.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904531361","type":"CDM"},{"code":"00904531361","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE CREAM 2-0.1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx00904535431","type":"CDM"},{"code":"00904535431","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENTOXIFYLLINE TAB ER 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904544861","type":"CDM"},{"code":"00904544861","type":"NDC"}],"standard_charges":[{"gross_charge":10.54,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-5 MCG(200 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904546072","type":"CDM"},{"code":"00904546072","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904549261","type":"CDM"},{"code":"00904549261","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904552361","type":"CDM"},{"code":"00904552361","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904555159","type":"CDM"},{"code":"00904555159","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904567761","type":"CDM"},{"code":"00904567761","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904571135","type":"CDM"},{"code":"00904571135","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578051","type":"CDM"},{"code":"00904578051","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUOXETINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578461","type":"CDM"},{"code":"00904578461","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUOXETINE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578561","type":"CDM"},{"code":"00904578561","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904578961","type":"CDM"},{"code":"00904578961","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904579061","type":"CDM"},{"code":"00904579061","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904582460","type":"CDM"},{"code":"00904582460","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904582461","type":"CDM"},{"code":"00904582461","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CETIRIZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904585246","type":"CDM"},{"code":"00904585246","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904585361","type":"CDM"},{"code":"00904585361","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904588061","type":"CDM"},{"code":"00904588061","type":"NDC"}],"standard_charges":[{"gross_charge":11.61,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904589261","type":"CDM"},{"code":"00904589261","type":"NDC"}],"standard_charges":[{"gross_charge":11.03,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SIMETHICONE SUSP 40 MG/0.6ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00904589430","type":"CDM"},{"code":"00904589430","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIGOXIN TAB 125 MCG (0.125 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592161","type":"CDM"},{"code":"00904592161","type":"NDC"}],"standard_charges":[{"gross_charge":11.77,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIGOXIN TAB 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592261","type":"CDM"},{"code":"00904592261","type":"NDC"}],"standard_charges":[{"gross_charge":12.15,"discounted_cash":8.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904592861","type":"CDM"},{"code":"00904592861","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904595961","type":"CDM"},{"code":"00904595961","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTIC ACID (AMMONIUM LACTATE) LOTION 12%","drug_information":{"unit":226.0,"type":"GM"},"code_information":[{"code":"Rx00904598426","type":"CDM"},{"code":"00904598426","type":"NDC"}],"standard_charges":[{"gross_charge":4.52,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904600761","type":"CDM"},{"code":"00904600761","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":8.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904600861","type":"CDM"},{"code":"00904600861","type":"NDC"}],"standard_charges":[{"gross_charge":11.69,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904605261","type":"CDM"},{"code":"00904605261","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904607461","type":"CDM"},{"code":"00904607461","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904608261","type":"CDM"},{"code":"00904608261","type":"NDC"}],"standard_charges":[{"gross_charge":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CITALOPRAM HYDROBROMIDE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904608561","type":"CDM"},{"code":"00904608561","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904615661","type":"CDM"},{"code":"00904615661","type":"NDC"}],"standard_charges":[{"gross_charge":10.78,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 50 MCG (2000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904615760","type":"CDM"},{"code":"00904615760","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904617261","type":"CDM"},{"code":"00904617261","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904618761","type":"CDM"},{"code":"00904618761","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904623761","type":"CDM"},{"code":"00904623761","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904623861","type":"CDM"},{"code":"00904623861","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904628361","type":"CDM"},{"code":"00904628361","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629006","type":"CDM"},{"code":"00904629006","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629061","type":"CDM"},{"code":"00904629061","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629206","type":"CDM"},{"code":"00904629206","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629261","type":"CDM"},{"code":"00904629261","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904629461","type":"CDM"},{"code":"00904629461","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904630061","type":"CDM"},{"code":"00904630061","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904630161","type":"CDM"},{"code":"00904630161","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904630361","type":"CDM"},{"code":"00904630361","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOL LIQUID 1.4%","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx00904630521","type":"CDM"},{"code":"00904630521","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROMETHORPHAN POLISTIREX EXTENDED RELEASE SUSP 30 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx00904631256","type":"CDM"},{"code":"00904631256","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632206","type":"CDM"},{"code":"00904632206","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632261","type":"CDM"},{"code":"00904632261","type":"NDC"}],"standard_charges":[{"gross_charge":11.18,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904632361","type":"CDM"},{"code":"00904632361","type":"NDC"}],"standard_charges":[{"gross_charge":11.11,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904634061","type":"CDM"},{"code":"00904634061","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904634161","type":"CDM"},{"code":"00904634161","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOFLOXACIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635161","type":"CDM"},{"code":"00904635161","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635261","type":"CDM"},{"code":"00904635261","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904635961","type":"CDM"},{"code":"00904635961","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637061","type":"CDM"},{"code":"00904637061","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637361","type":"CDM"},{"code":"00904637361","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904637461","type":"CDM"},{"code":"00904637461","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904639161","type":"CDM"},{"code":"00904639161","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904640161","type":"CDM"},{"code":"00904640161","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BISACODYL TAB DELAYED RELEASE 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904640761","type":"CDM"},{"code":"00904640761","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904640861","type":"CDM"},{"code":"00904640861","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM CARBONATE (ANTACID) CHEW TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904641292","type":"CDM"},{"code":"00904641292","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904641861","type":"CDM"},{"code":"00904641861","type":"NDC"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642281","type":"CDM"},{"code":"00904642281","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642286","type":"CDM"},{"code":"00904642286","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642561","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00904642561","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642661","type":"CDM"},{"code":"00904642661","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 20 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904642761","type":"CDM"},{"code":"00904642761","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904643761","type":"CDM"},{"code":"00904643761","type":"NDC"}],"standard_charges":[{"gross_charge":11.96,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904644161","type":"CDM"},{"code":"00904644161","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904644961","type":"CDM"},{"code":"00904644961","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904645061","type":"CDM"},{"code":"00904645061","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904645561","type":"CDM"},{"code":"00904645561","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904646161","type":"CDM"},{"code":"00904646161","type":"NDC"}],"standard_charges":[{"gross_charge":10.12,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904646707","type":"CDM"},{"code":"00904646707","type":"NDC"}],"standard_charges":[{"gross_charge":29.24,"discounted_cash":20.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904646710","type":"CDM"},{"code":"00904646710","type":"NDC"}],"standard_charges":[{"gross_charge":19.66,"discounted_cash":13.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904646861","type":"CDM"},{"code":"00904646861","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647461","type":"CDM"},{"code":"00904647461","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647561","type":"CDM"},{"code":"00904647561","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904647761","type":"CDM"},{"code":"00904647761","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904648661","type":"CDM"},{"code":"00904648661","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx00904648838","type":"CDM"},{"code":"00904648838","type":"NDC"}],"standard_charges":[{"gross_charge":4.84,"discounted_cash":3.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650006","type":"CDM"},{"code":"00904650006","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650061","type":"CDM"},{"code":"00904650061","type":"NDC"}],"standard_charges":[{"gross_charge":12.35,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650261","type":"CDM"},{"code":"00904650261","type":"NDC"}],"standard_charges":[{"gross_charge":11.52,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650606","type":"CDM"},{"code":"00904650606","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEMANTINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904650661","type":"CDM"},{"code":"00904650661","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904651006","type":"CDM"},{"code":"00904651006","type":"NDC"}],"standard_charges":[{"gross_charge":19.49,"discounted_cash":13.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MECLIZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904651761","type":"CDM"},{"code":"00904651761","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904651961","type":"CDM"},{"code":"00904651961","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES TAB 8.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904652261","type":"CDM"},{"code":"00904652261","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904653061","type":"CDM"},{"code":"00904653061","type":"NDC"}],"standard_charges":[{"gross_charge":11.89,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655304","type":"CDM"},{"code":"00904655304","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655461","type":"CDM"},{"code":"00904655461","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655661","type":"CDM"},{"code":"00904655661","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655761","type":"CDM"},{"code":"00904655761","type":"NDC"}],"standard_charges":[{"gross_charge":12.94,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904655861","type":"CDM"},{"code":"00904655861","type":"NDC"}],"standard_charges":[{"gross_charge":13.68,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656461","type":"CDM"},{"code":"00904656461","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656507","type":"CDM"},{"code":"00904656507","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904656561","type":"CDM"},{"code":"00904656561","type":"NDC"}],"standard_charges":[{"gross_charge":12.51,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657006","type":"CDM"},{"code":"00904657006","type":"NDC"}],"standard_charges":[{"gross_charge":12.31,"discounted_cash":8.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657161","type":"CDM"},{"code":"00904657161","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOBARBITAL TAB 32.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904657561","type":"CDM"},{"code":"00904657561","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904658561","type":"CDM"},{"code":"00904658561","type":"NDC"}],"standard_charges":[{"gross_charge":10.87,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904659204","type":"CDM"},{"code":"00904659204","type":"NDC"}],"standard_charges":[{"gross_charge":19.82,"discounted_cash":13.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904661561","type":"CDM"},{"code":"00904661561","type":"NDC"}],"standard_charges":[{"gross_charge":11.69,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TACROLIMUS CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904662361","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"00904662361","type":"NDC"}],"standard_charges":[{"gross_charge":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBAMIDE PEROXIDE 6.5% OTIC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904662735","type":"CDM"},{"code":"00904662735","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663006","type":"CDM"},{"code":"00904663006","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663561","type":"CDM"},{"code":"00904663561","type":"NDC"}],"standard_charges":[{"gross_charge":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLIPIZIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663761","type":"CDM"},{"code":"00904663761","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904663861","type":"CDM"},{"code":"00904663861","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904664061","type":"CDM"},{"code":"00904664061","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666561","type":"CDM"},{"code":"00904666561","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666661","type":"CDM"},{"code":"00904666661","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904666761","type":"CDM"},{"code":"00904666761","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SILDENAFIL CITRATE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904667104","type":"CDM"},{"code":"00904667104","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904668961","type":"CDM"},{"code":"00904668961","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670461","type":"CDM"},{"code":"00904670461","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670506","type":"CDM"},{"code":"00904670506","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670561","type":"CDM"},{"code":"00904670561","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904670806","type":"CDM"},{"code":"00904670806","type":"NDC"}],"standard_charges":[{"gross_charge":11.31,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CETIRIZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904671761","type":"CDM"},{"code":"00904671761","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN TAB ER 12HR 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904671839","type":"CDM"},{"code":"00904671839","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES TAB 8.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904672559","type":"CDM"},{"code":"00904672559","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904673061","type":"CDM"},{"code":"00904673061","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904674561","type":"CDM"},{"code":"00904674561","type":"NDC"}],"standard_charges":[{"gross_charge":17.32,"discounted_cash":12.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00904676130","type":"CDM"},{"code":"00904676130","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904677361","type":"CDM"},{"code":"00904677361","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904677861","type":"CDM"},{"code":"00904677861","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904678061","type":"CDM"},{"code":"00904678061","type":"NDC"}],"standard_charges":[{"gross_charge":11.83,"discounted_cash":8.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679061","type":"CDM"},{"code":"00904679061","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679430","type":"CDM"},{"code":"00904679430","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679761","type":"CDM"},{"code":"00904679761","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679861","type":"CDM"},{"code":"00904679861","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904679961","type":"CDM"},{"code":"00904679961","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904680806","type":"CDM"},{"code":"00904680806","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904680861","type":"CDM"},{"code":"00904680861","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904681004","type":"CDM"},{"code":"00904681004","type":"NDC"}],"standard_charges":[{"gross_charge":13.62,"discounted_cash":9.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904681861","type":"CDM"},{"code":"00904681861","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682461","type":"CDM"},{"code":"00904682461","type":"NDC"}],"standard_charges":[{"gross_charge":11.94,"discounted_cash":8.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904682561","type":"CDM"},{"code":"00904682561","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904683006","type":"CDM"},{"code":"00904683006","type":"NDC"}],"standard_charges":[{"gross_charge":10.89,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOPERAMIDE HCL SOLN 1 MG/7.5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx00904683620","type":"CDM"},{"code":"00904683620","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx00904684673","type":"CDM"},{"code":"00904684673","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904685261","type":"CDM"},{"code":"00904685261","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904686061","type":"CDM"},{"code":"00904686061","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904686861","type":"CDM"},{"code":"00904686861","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904687045","type":"CDM"},{"code":"00904687045","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904688210","type":"CDM"},{"code":"00904688210","type":"NDC"}],"standard_charges":[{"gross_charge":128.87,"discounted_cash":90.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"URSODIOL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904689004","type":"CDM"},{"code":"00904689004","type":"NDC"}],"standard_charges":[{"gross_charge":13.96,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904691461","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"00904691461","type":"NDC"}],"standard_charges":[{"gross_charge":12.57,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOLAZONE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904691661","type":"CDM"},{"code":"00904691661","type":"NDC"}],"standard_charges":[{"gross_charge":13.68,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692361","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00904692361","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SERTRALINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692461","type":"CDM"},{"code":"00904692461","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692561","type":"CDM"},{"code":"00904692561","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692761","type":"CDM"},{"code":"00904692761","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904692861","type":"CDM"},{"code":"00904692861","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904693176","type":"CDM"},{"code":"00904693176","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904693186","type":"CDM"},{"code":"00904693186","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904693806","type":"CDM"},{"code":"00904693806","type":"NDC"}],"standard_charges":[{"gross_charge":12.08,"discounted_cash":8.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904694961","type":"CDM"},{"code":"00904694961","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695061","type":"CDM"},{"code":"00904695061","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695261","type":"CDM"},{"code":"00904695261","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695361","type":"CDM"},{"code":"00904695361","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695461","type":"CDM"},{"code":"00904695461","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695561","type":"CDM"},{"code":"00904695561","type":"NDC"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904695661","type":"CDM"},{"code":"00904695661","type":"NDC"}],"standard_charges":[{"gross_charge":11.08,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904696661","type":"CDM"},{"code":"00904696661","type":"NDC"}],"standard_charges":[{"gross_charge":12.05,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904698761","type":"CDM"},{"code":"00904698761","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PSEUDOEPHEDRINE HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699061","type":"CDM"},{"code":"00904699061","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699104","type":"CDM"},{"code":"00904699104","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":8.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699161","type":"CDM"},{"code":"00904699161","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":8.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699261","type":"CDM"},{"code":"00904699261","type":"NDC"}],"standard_charges":[{"gross_charge":12.49,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904699361","type":"CDM"},{"code":"00904699361","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904700635","type":"CDM"},{"code":"00904700635","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904700761","type":"CDM"},{"code":"00904700761","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904700861","type":"CDM"},{"code":"00904700861","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904701606","type":"CDM"},{"code":"00904701606","type":"NDC"}],"standard_charges":[{"gross_charge":11.49,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904702061","type":"CDM"},{"code":"00904702061","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904702761","type":"CDM"},{"code":"00904702761","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704161","type":"CDM"},{"code":"00904704161","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMANTADINE HCL CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704206","type":"CDM"},{"code":"00904704206","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704304","type":"CDM"},{"code":"00904704304","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704461","type":"CDM"},{"code":"00904704461","type":"NDC"}],"standard_charges":[{"gross_charge":11.83,"discounted_cash":8.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704606","type":"CDM"},{"code":"00904704606","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704661","type":"CDM"},{"code":"00904704661","type":"NDC"}],"standard_charges":[{"gross_charge":12.33,"discounted_cash":8.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704761","type":"CDM"},{"code":"00904704761","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904704861","type":"CDM"},{"code":"00904704861","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXEPIN HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705261","type":"CDM"},{"code":"00904705261","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705361","type":"CDM"},{"code":"00904705361","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705761","type":"CDM"},{"code":"00904705761","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904705861","type":"CDM"},{"code":"00904705861","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904706561","type":"CDM"},{"code":"00904706561","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707007","type":"CDM"},{"code":"00904707007","type":"NDC"}],"standard_charges":[{"gross_charge":14.36,"discounted_cash":10.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707461","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00904707461","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707561","type":"CDM"},{"code":"00904707561","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707761","type":"CDM"},{"code":"00904707761","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904707861","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"00904707861","type":"NDC"}],"standard_charges":[{"gross_charge":11.49,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708404","type":"CDM"},{"code":"00904708404","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708461","type":"CDM"},{"code":"00904708461","type":"NDC"}],"standard_charges":[{"gross_charge":12.48,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904708561","type":"CDM"},{"code":"00904708561","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904710561","type":"CDM"},{"code":"00904710561","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":8.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904710961","type":"CDM"},{"code":"00904710961","type":"NDC"}],"standard_charges":[{"gross_charge":10.54,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904711861","type":"CDM"},{"code":"00904711861","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904711906","type":"CDM"},{"code":"00904711906","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":8.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904711961","type":"CDM"},{"code":"00904711961","type":"NDC"}],"standard_charges":[{"gross_charge":11.87,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712004","type":"CDM"},{"code":"00904712004","type":"NDC"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":11.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712161","type":"CDM"},{"code":"00904712161","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712261","type":"CDM"},{"code":"00904712261","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712461","type":"CDM"},{"code":"00904712461","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712661","type":"CDM"},{"code":"00904712661","type":"NDC"}],"standard_charges":[{"gross_charge":11.05,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712761","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"00904712761","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904712804","type":"CDM"},{"code":"00904712804","type":"NDC"}],"standard_charges":[{"gross_charge":13.9,"discounted_cash":9.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904714361","type":"CDM"},{"code":"00904714361","type":"NDC"}],"standard_charges":[{"gross_charge":11.81,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715361","type":"CDM"},{"code":"00904715361","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715404","type":"CDM"},{"code":"00904715404","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904715661","type":"CDM"},{"code":"00904715661","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904716261","type":"CDM"},{"code":"00904716261","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EMTRICITABINE-TENOFOVIR DISOPROXIL FUMARATE TAB 200-300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904717207","type":"CDM"},{"code":"00904717207","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":9.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904717761","type":"CDM"},{"code":"00904717761","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904717861","type":"CDM"},{"code":"00904717861","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904718361","type":"CDM"},{"code":"00904718361","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904719106","type":"CDM"},{"code":"00904719106","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904719306","type":"CDM"},{"code":"00904719306","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904719361","type":"CDM"},{"code":"00904719361","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904719907","type":"CDM"},{"code":"00904719907","type":"NDC"}],"standard_charges":[{"gross_charge":12.05,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904720806","type":"CDM"},{"code":"00904720806","type":"NDC"}],"standard_charges":[{"gross_charge":11.42,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721461","type":"CDM"},{"code":"00904721461","type":"NDC"}],"standard_charges":[{"gross_charge":10.89,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904721761","type":"CDM"},{"code":"00904721761","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904722461","type":"CDM"},{"code":"00904722461","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904722761","type":"CDM"},{"code":"00904722761","type":"NDC"}],"standard_charges":[{"gross_charge":12.24,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904722961","type":"CDM"},{"code":"00904722961","type":"NDC"}],"standard_charges":[{"gross_charge":11.77,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904723761","type":"CDM"},{"code":"Q0163","type":"HCPCS"},{"code":"00904723761","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904723961","type":"CDM"},{"code":"00904723961","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACOSAMIDE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904724668","type":"CDM"},{"code":"00904724668","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES TAB 8.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904725261","type":"CDM"},{"code":"00904725261","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904725761","type":"CDM"},{"code":"00904725761","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904726161","type":"CDM"},{"code":"00904726161","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904726261","type":"CDM"},{"code":"00904726261","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904727061","type":"CDM"},{"code":"00904727061","type":"NDC"}],"standard_charges":[{"gross_charge":11.31,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904727641","type":"CDM"},{"code":"00904727641","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904728306","type":"CDM"},{"code":"00904728306","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx00904728454","type":"CDM"},{"code":"00904728454","type":"NDC"}],"standard_charges":[{"gross_charge":58.3,"discounted_cash":40.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx00904728469","type":"CDM"},{"code":"00904728469","type":"NDC"}],"standard_charges":[{"gross_charge":56.42,"discounted_cash":39.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904728961","type":"CDM"},{"code":"00904728961","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904729261","type":"CDM"},{"code":"00904729261","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730461","type":"CDM"},{"code":"00904730461","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730561","type":"CDM"},{"code":"00904730561","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730661","type":"CDM"},{"code":"00904730661","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904730861","type":"CDM"},{"code":"00904730861","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904732341","type":"CDM"},{"code":"00904732341","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904732370","type":"CDM"},{"code":"00904732370","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904732562","type":"CDM"},{"code":"00904732562","type":"NDC"}],"standard_charges":[{"gross_charge":9.34,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx00904732573","type":"CDM"},{"code":"00904732573","type":"NDC"}],"standard_charges":[{"gross_charge":9.34,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOLAZONE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904732861","type":"CDM"},{"code":"00904732861","type":"NDC"}],"standard_charges":[{"gross_charge":14.7,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904733735","type":"CDM"},{"code":"00904733735","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUOXETINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904734561","type":"CDM"},{"code":"00904734561","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUOXETINE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904734661","type":"CDM"},{"code":"00904734661","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904735006","type":"CDM"},{"code":"00904735006","type":"NDC"}],"standard_charges":[{"gross_charge":11.33,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736261","type":"CDM"},{"code":"00904736261","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736706","type":"CDM"},{"code":"00904736706","type":"NDC"}],"standard_charges":[{"gross_charge":10.94,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904736806","type":"CDM"},{"code":"00904736806","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MECLIZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904737661","type":"CDM"},{"code":"00904737661","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904738206","type":"CDM"},{"code":"00904738206","type":"NDC"}],"standard_charges":[{"gross_charge":12.37,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904738361","type":"CDM"},{"code":"00904738361","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904739161","type":"CDM"},{"code":"00904739161","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 1000 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904740361","type":"CDM"},{"code":"00904740361","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904741061","type":"CDM"},{"code":"00904741061","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904741761","type":"CDM"},{"code":"00904741761","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM CITRATE SOLN","drug_information":{"unit":296.0,"type":"ML"},"code_information":[{"code":"Rx00904741844","type":"CDM"},{"code":"00904741844","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904743535","type":"CDM"},{"code":"00904743535","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904744061","type":"CDM"},{"code":"00904744061","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904744261","type":"CDM"},{"code":"00904744261","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904744861","type":"CDM"},{"code":"00904744861","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904745161","type":"CDM"},{"code":"00904745161","type":"NDC"}],"standard_charges":[{"gross_charge":10.78,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBAMIDE PEROXIDE 6.5% OTIC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00904747835","type":"CDM"},{"code":"00904747835","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904749661","type":"CDM"},{"code":"00904749661","type":"NDC"}],"standard_charges":[{"gross_charge":11.78,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904750504","type":"CDM"},{"code":"00904750504","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904752841","type":"CDM"},{"code":"00904752841","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx00904752894","type":"CDM"},{"code":"00904752894","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FERROUS SULFATE TAB 325 MG (65 MG ELEMENTAL FE)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904759161","type":"CDM"},{"code":"00904759161","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICONAZOLE NITRATE VAGINAL CREAM 2%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx00904773445","type":"CDM"},{"code":"00904773445","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904780961","type":"CDM"},{"code":"00904780961","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904791461","type":"CDM"},{"code":"00904791461","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00904880567","type":"CDM"},{"code":"00904880567","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUCROSE 24 % ORAL SOLUTION","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx00906990441","type":"CDM"},{"code":"00906990441","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00944270004","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270004","type":"NDC"}],"standard_charges":[{"gross_charge":1461.66,"discounted_cash":1023.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx00944270005","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270005","type":"NDC"}],"standard_charges":[{"gross_charge":2923.32,"discounted_cash":2046.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx00944270006","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270006","type":"NDC"}],"standard_charges":[{"gross_charge":5846.64,"discounted_cash":4092.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 30 GM/300ML","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx00944270007","type":"CDM"},{"code":"J1569","type":"HCPCS"},{"code":"00944270007","type":"NDC"}],"standard_charges":[{"gross_charge":8769.96,"discounted_cash":6138.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx00955100310","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955100310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx00955100410","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955100410","type":"NDC"}],"standard_charges":[{"gross_charge":126.26,"discounted_cash":88.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx00955100610","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955100610","type":"NDC"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx00955100810","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955100810","type":"NDC"}],"standard_charges":[{"gross_charge":221.15,"discounted_cash":154.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx00955101010","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955101010","type":"NDC"}],"standard_charges":[{"gross_charge":284.39,"discounted_cash":199.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx00955101210","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955101210","type":"NDC"}],"standard_charges":[{"gross_charge":347.52,"discounted_cash":243.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx00955101510","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"00955101510","type":"NDC"}],"standard_charges":[{"gross_charge":410.74,"discounted_cash":287.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SEVELAMER CARBONATE TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx00955105027","type":"CDM"},{"code":"00955105027","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 0.9%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx00990798413","type":"CDM"},{"code":"J7050","type":"HCPCS"},{"code":"00990798413","type":"NDC"}],"standard_charges":[{"gross_charge":151.01,"discounted_cash":105.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPARACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00998001615","type":"CDM"},{"code":"00998001615","type":"NDC"}],"standard_charges":[{"gross_charge":127.99,"discounted_cash":89.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 2%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00998020415","type":"CDM"},{"code":"00998020415","type":"NDC"}],"standard_charges":[{"gross_charge":303.72,"discounted_cash":212.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 4%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx00998020615","type":"CDM"},{"code":"00998020615","type":"NDC"}],"standard_charges":[{"gross_charge":315.82,"discounted_cash":221.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM HYALURONATE INTRAOCULAR SOLN PREF SYR 5.5 MG/0.55ML","drug_information":{"unit":0.55,"type":"ML"},"code_information":[{"code":"Rx08065183055","type":"CDM"},{"code":"08065183055","type":"NDC"}],"standard_charges":[{"gross_charge":648.39,"discounted_cash":453.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NA CHONDROIT SULF-NA HYALURON PREF SYR 20-15 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx08065183905","type":"CDM"},{"code":"08065183905","type":"NDC"}],"standard_charges":[{"gross_charge":980.23,"discounted_cash":686.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NA CHONDROIT SULF-NA HYALURON PREF SYR 30-22.5 MG/0.75ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx08065183975","type":"CDM"},{"code":"08065183975","type":"NDC"}],"standard_charges":[{"gross_charge":1052.49,"discounted_cash":736.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 100 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx08290306424","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"08290306424","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM HYALURONATE INTRAOCULAR SOLN PREF SYR 13.8 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx08544508321","type":"CDM"},{"code":"08544508321","type":"NDC"}],"standard_charges":[{"gross_charge":1493.41,"discounted_cash":1045.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM CHLORIDE TAB DR 64 MG (ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006070013","type":"CDM"},{"code":"10006070013","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM OXIDE TAB 400 MG (240 MG ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006070028","type":"CDM"},{"code":"10006070028","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006070031","type":"CDM"},{"code":"10006070031","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006070033","type":"CDM"},{"code":"10006070033","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VITAMIN E CAP 180 MG (400 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006070034","type":"CDM"},{"code":"10006070034","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-5 MCG(200 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10006070038","type":"CDM"},{"code":"10006070038","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx10019005561","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"10019005561","type":"NDC"}],"standard_charges":[{"gross_charge":779.21,"discounted_cash":545.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 40 MG/200ML IN SODIUM CHLORIDE 0.83%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx10122032501","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"10122032501","type":"NDC"}],"standard_charges":[{"gross_charge":1123.3,"discounted_cash":786.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 40 MG/200ML IN SODIUM CHLORIDE 0.83%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx10122032510","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"10122032510","type":"NDC"}],"standard_charges":[{"gross_charge":1123.3,"discounted_cash":786.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10135016813","type":"CDM"},{"code":"10135016813","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOCONAZOLE SHAMPOO 2%","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx10147075004","type":"CDM"},{"code":"10147075004","type":"NDC"}],"standard_charges":[{"gross_charge":72.6,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx10147091101","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"10147091101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"B-COMPLEX W/ C & FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10542001010","type":"CDM"},{"code":"10542001010","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10702001801","type":"CDM"},{"code":"10702001801","type":"NDC"}],"standard_charges":[{"gross_charge":11.78,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOSPORINE (OPHTH) EMULSION 0.05%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx10702080803","type":"CDM"},{"code":"10702080803","type":"NDC"}],"standard_charges":[{"gross_charge":14.78,"discounted_cash":10.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11523716002","type":"CDM"},{"code":"11523716002","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VITAMINS A & D OINT","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx11523720401","type":"CDM"},{"code":"11523720401","type":"NDC"}],"standard_charges":[{"gross_charge":3.35,"discounted_cash":2.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL POWDER 17 GM/SCOOP","drug_information":{"unit":238.0,"type":"GM"},"code_information":[{"code":"Rx11523723403","type":"CDM"},{"code":"11523723403","type":"NDC"}],"standard_charges":[{"gross_charge":14.99,"discounted_cash":10.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11523726808","type":"CDM"},{"code":"11523726808","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11534016501","type":"CDM"},{"code":"11534016501","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICONAZOLE NITRATE POWDER 2%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx11701003816","type":"CDM"},{"code":"11701003816","type":"NDC"}],"standard_charges":[{"gross_charge":7.99,"discounted_cash":5.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXOCOBALAMIN (ANTIDOTE) FOR IV SOLN 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx11704037001","type":"CDM"},{"code":"11704037001","type":"NDC"}],"standard_charges":[{"gross_charge":3348.61,"discounted_cash":2344.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUCROSE 24 % ORAL SOLUTION","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx11743002235","type":"CDM"},{"code":"11743002235","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MENTHOL-METHYL SALICYLATE OINTMENT","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx11917006937","type":"CDM"},{"code":"11917006937","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":4.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISOLONE ACETATE OPHTH SUSP 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx11980018005","type":"CDM"},{"code":"11980018005","type":"NDC"}],"standard_charges":[{"gross_charge":393.64,"discounted_cash":275.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MENTHOL LOZENGE 5.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12546000157","type":"CDM"},{"code":"12546000157","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MENTHOL LOZENGE 5.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12546062141","type":"CDM"},{"code":"12546062141","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THROAT LOZENGES - LOZENGES","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12546062936","type":"CDM"},{"code":"12546062936","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx12870000101","type":"CDM"},{"code":"12870000101","type":"NDC"}],"standard_charges":[{"gross_charge":11.51,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RABIES IMMUNE GLOBULIN (HUMAN) INJ 1500 UNT/5ML (300 UNT/ML),RABIES IMMUNE GLOBULIN (HUMAN) INJ 300 UNIT/ML,RABIES IMMUNE GLOBULIN (HUMAN) INJ 900 UNT/3ML (300 UNT/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx13533031801","type":"CDM"},{"code":"90375","type":"HCPCS"},{"code":"13533031801","type":"NDC"}],"standard_charges":[{"gross_charge":1819.76,"discounted_cash":1273.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RABIES IMMUNE GLOBULIN (HUMAN) INJ 1500 UNT/5ML (300 UNT/ML),RABIES IMMUNE GLOBULIN (HUMAN) INJ 300 UNIT/ML,RABIES IMMUNE GLOBULIN (HUMAN) INJ 900 UNT/3ML (300 UNT/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx13533031805","type":"CDM"},{"code":"90375","type":"HCPCS"},{"code":"13533031805","type":"NDC"}],"standard_charges":[{"gross_charge":9098.72,"discounted_cash":6369.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13533063102","type":"CDM"},{"code":"J2790","type":"HCPCS"},{"code":"13533063102","type":"NDC"}],"standard_charges":[{"gross_charge":1176.6,"discounted_cash":823.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13533063111","type":"CDM"},{"code":"J2790","type":"HCPCS"},{"code":"13533063111","type":"NDC"}],"standard_charges":[{"gross_charge":1143.06,"discounted_cash":800.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TETANUS IMMUNE GLOBULIN (HUMAN) IM SOLN PREF SYR 250 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx13533063402","type":"CDM"},{"code":"J1670","type":"HCPCS"},{"code":"13533063402","type":"NDC"}],"standard_charges":[{"gross_charge":2131.96,"discounted_cash":1492.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN (HUMAN) IM SOLN 220 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx13533063601","type":"CDM"},{"code":"90371","type":"HCPCS"},{"code":"13533063601","type":"NDC"}],"standard_charges":[{"gross_charge":1851.57,"discounted_cash":1296.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 5 GM/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx13533080020","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080020","type":"NDC"}],"standard_charges":[{"gross_charge":1327.83,"discounted_cash":929.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx13533080024","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080024","type":"NDC"}],"standard_charges":[{"gross_charge":5311.34,"discounted_cash":3717.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 40 GM/400ML","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"Rx13533080040","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080040","type":"NDC"}],"standard_charges":[{"gross_charge":10622.68,"discounted_cash":7435.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx13533080071","type":"CDM"},{"code":"J1561","type":"HCPCS"},{"code":"13533080071","type":"NDC"}],"standard_charges":[{"gross_charge":2655.67,"discounted_cash":1858.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668000701","type":"CDM"},{"code":"13668000701","type":"NDC"}],"standard_charges":[{"gross_charge":11.61,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668009290","type":"CDM"},{"code":"13668009290","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668013301","type":"CDM"},{"code":"13668013301","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13668072090","type":"CDM"},{"code":"13668072090","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13811068130","type":"CDM"},{"code":"13811068130","type":"NDC"}],"standard_charges":[{"gross_charge":24.67,"discounted_cash":17.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx13811071910","type":"CDM"},{"code":"13811071910","type":"NDC"}],"standard_charges":[{"gross_charge":12.56,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx14428000944","type":"CDM"},{"code":"14428000944","type":"NDC"}],"standard_charges":[{"gross_charge":3.27,"discounted_cash":2.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx14789010910","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"14789010910","type":"NDC"}],"standard_charges":[{"gross_charge":495.3,"discounted_cash":346.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 10 MEQ/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx14789010916","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"14789010916","type":"NDC"}],"standard_charges":[{"gross_charge":495.3,"discounted_cash":346.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx14789022008","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"14789022008","type":"NDC"}],"standard_charges":[{"gross_charge":200.59,"discounted_cash":140.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx14789022010","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"14789022010","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx14789033008","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"14789033008","type":"NDC"}],"standard_charges":[{"gross_charge":286.99,"discounted_cash":200.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 4%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx16571011148","type":"CDM"},{"code":"16571011148","type":"NDC"}],"standard_charges":[{"gross_charge":9.46,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571067642","type":"CDM"},{"code":"16571067642","type":"NDC"}],"standard_charges":[{"gross_charge":12.76,"discounted_cash":8.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NATEGLINIDE TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16571075909","type":"CDM"},{"code":"16571075909","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16714008110","type":"CDM"},{"code":"16714008110","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16714071301","type":"CDM"},{"code":"16714071301","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729000201","type":"CDM"},{"code":"16729000201","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729001901","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"16729001901","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729002110","type":"CDM"},{"code":"16729002110","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729002115","type":"CDM"},{"code":"16729002115","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729009001","type":"CDM"},{"code":"16729009001","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729009010","type":"CDM"},{"code":"16729009010","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729009015","type":"CDM"},{"code":"16729009015","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729009401","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"16729009401","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729017101","type":"CDM"},{"code":"16729017101","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729018301","type":"CDM"},{"code":"16729018301","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 360 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729018929","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"16729018929","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729020001","type":"CDM"},{"code":"16729020001","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx16729025938","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"16729025938","type":"NDC"}],"standard_charges":[{"gross_charge":969.9,"discounted_cash":678.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729043505","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"16729043505","type":"NDC"}],"standard_charges":[{"gross_charge":461.57,"discounted_cash":323.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx16729047208","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"16729047208","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx16729047230","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"16729047230","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx16729047801","type":"CDM"},{"code":"16729047801","type":"NDC"}],"standard_charges":[{"gross_charge":11.87,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx16729050143","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"16729050143","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx16729050164","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"16729050164","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZOCAINE-MENTHOL AEROSOL 20-0.5%","drug_information":{"unit":56.0,"type":"GM"},"code_information":[{"code":"Rx16864068002","type":"CDM"},{"code":"16864068002","type":"NDC"}],"standard_charges":[{"gross_charge":3.97,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYPROMELLOSE GONIOSCOPIC SOLN 2.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17238061015","type":"CDM"},{"code":"17238061015","type":"NDC"}],"standard_charges":[{"gross_charge":8.38,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478001202","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"17478001202","type":"NDC"}],"standard_charges":[{"gross_charge":242.37,"discounted_cash":169.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx17478003005","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"17478003005","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM INJ 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478004001","type":"CDM"},{"code":"J2060","type":"HCPCS"},{"code":"17478004001","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUFENTANIL CITRATE INJ 50 MCG/ML","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"Rx17478005001","type":"CDM"},{"code":"17478005001","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYVINYL ALCOHOL OPHTH SOLN 1.4%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478006012","type":"CDM"},{"code":"17478006012","type":"NDC"}],"standard_charges":[{"gross_charge":7.69,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYPROMELLOSE GONIOSCOPIC SOLN 2.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478006412","type":"CDM"},{"code":"17478006412","type":"NDC"}],"standard_charges":[{"gross_charge":25.15,"discounted_cash":17.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALFENTANIL HCL IV SOLN 1000 MCG/2ML (500 MCG/ML) (BASE EQ),ALFENTANIL HCL IV SOLN 2500 MCG/5ML (500 MCG/ML) (BASE EQ)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478006702","type":"CDM"},{"code":"J0216","type":"HCPCS"},{"code":"17478006702","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478008130","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"17478008130","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478010002","type":"CDM"},{"code":"17478010002","type":"NDC"}],"standard_charges":[{"gross_charge":81.7,"discounted_cash":57.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478010212","type":"CDM"},{"code":"17478010212","type":"NDC"}],"standard_charges":[{"gross_charge":72.95,"discounted_cash":51.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478017101","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"17478017101","type":"NDC"}],"standard_charges":[{"gross_charge":14.81,"discounted_cash":10.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478017130","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"17478017130","type":"NDC"}],"standard_charges":[{"gross_charge":21.83,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478020102","type":"CDM"},{"code":"17478020102","type":"NDC"}],"standard_charges":[{"gross_charge":136.37,"discounted_cash":95.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478020605","type":"CDM"},{"code":"17478020605","type":"NDC"}],"standard_charges":[{"gross_charge":156.18,"discounted_cash":109.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx17478020911","type":"CDM"},{"code":"17478020911","type":"NDC"}],"standard_charges":[{"gross_charge":83.12,"discounted_cash":58.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx17478020919","type":"CDM"},{"code":"17478020919","type":"NDC"}],"standard_charges":[{"gross_charge":89.39,"discounted_cash":62.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478021502","type":"CDM"},{"code":"17478021502","type":"NDC"}],"standard_charges":[{"gross_charge":151.66,"discounted_cash":106.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478021505","type":"CDM"},{"code":"17478021505","type":"NDC"}],"standard_charges":[{"gross_charge":186.1,"discounted_cash":130.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478021515","type":"CDM"},{"code":"17478021515","type":"NDC"}],"standard_charges":[{"gross_charge":399.41,"discounted_cash":279.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPARACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478026312","type":"CDM"},{"code":"17478026312","type":"NDC"}],"standard_charges":[{"gross_charge":142.93,"discounted_cash":100.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GENTAMICIN SULFATE OPHTH OINT 0.3%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx17478028435","type":"CDM"},{"code":"17478028435","type":"NDC"}],"standard_charges":[{"gross_charge":133.4,"discounted_cash":93.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478028810","type":"CDM"},{"code":"17478028810","type":"NDC"}],"standard_charges":[{"gross_charge":69.18,"discounted_cash":48.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478029010","type":"CDM"},{"code":"17478029010","type":"NDC"}],"standard_charges":[{"gross_charge":81.47,"discounted_cash":57.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUORESCEIN SODIUM OPHTH STRIPS 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx17478040401","type":"CDM"},{"code":"17478040401","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478050401","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"17478050401","type":"NDC"}],"standard_charges":[{"gross_charge":1061.61,"discounted_cash":743.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYSOSTIGMINE SALICYLATE INJ 1 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx17478051002","type":"CDM"},{"code":"17478051002","type":"NDC"}],"standard_charges":[{"gross_charge":285.51,"discounted_cash":199.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPHEDRINE SULFATE INJ 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx17478051500","type":"CDM"},{"code":"17478051500","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478054202","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"17478054202","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE HYPERTONIC OPHTH SOLN 5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx17478062312","type":"CDM"},{"code":"17478062312","type":"NDC"}],"standard_charges":[{"gross_charge":15.09,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478071110","type":"CDM"},{"code":"17478071110","type":"NDC"}],"standard_charges":[{"gross_charge":69.26,"discounted_cash":48.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx17478071130","type":"CDM"},{"code":"17478071130","type":"NDC"}],"standard_charges":[{"gross_charge":244.11,"discounted_cash":170.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478071131","type":"CDM"},{"code":"17478071131","type":"NDC"}],"standard_charges":[{"gross_charge":68.99,"discounted_cash":48.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"APRACLONIDINE HCL OPHTH SOLN 0.5% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478071610","type":"CDM"},{"code":"17478071610","type":"NDC"}],"standard_charges":[{"gross_charge":237.43,"discounted_cash":166.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOTIFEN FUMARATE OPHTH SOLN 0.035%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx17478071710","type":"CDM"},{"code":"17478071710","type":"NDC"}],"standard_charges":[{"gross_charge":12.64,"discounted_cash":8.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL OPHTH GEL 3.5%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx17478079201","type":"CDM"},{"code":"17478079201","type":"NDC"}],"standard_charges":[{"gross_charge":103.94,"discounted_cash":72.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478093705","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"17478093705","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML)","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx17478093725","type":"CDM"},{"code":"17478093725","type":"NDC"}],"standard_charges":[{"gross_charge":159.39,"discounted_cash":111.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx17478095302","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"17478095302","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYALURONIDASE HUMAN INJ 150 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx18657011701","type":"CDM"},{"code":"J3473","type":"HCPCS"},{"code":"18657011701","type":"NDC"}],"standard_charges":[{"gross_charge":575.46,"discounted_cash":402.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYALURONIDASE HUMAN INJ 150 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx18657011702","type":"CDM"},{"code":"J3473","type":"HCPCS"},{"code":"18657011702","type":"NDC"}],"standard_charges":[{"gross_charge":588.9,"discounted_cash":412.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYALURONIDASE HUMAN INJ 150 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx18657011704","type":"CDM"},{"code":"J3473","type":"HCPCS"},{"code":"18657011704","type":"NDC"}],"standard_charges":[{"gross_charge":586.15,"discounted_cash":410.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FERROUS GLUCONATE TAB 324 MG (37.5 MG ELEMENTAL IRON)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555001900","type":"CDM"},{"code":"20555001900","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555003300","type":"CDM"},{"code":"20555003300","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555003600","type":"CDM"},{"code":"20555003600","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555003601","type":"CDM"},{"code":"20555003601","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZINC SULFATE CAP 220 MG (50 MG ELEMENTAL ZN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx20555004000","type":"CDM"},{"code":"20555004000","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx21922001704","type":"CDM"},{"code":"21922001704","type":"NDC"}],"standard_charges":[{"gross_charge":63.66,"discounted_cash":44.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PERMETHRIN CREAM 5%","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx21922002107","type":"CDM"},{"code":"21922002107","type":"NDC"}],"standard_charges":[{"gross_charge":103.53,"discounted_cash":72.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx21922006204","type":"CDM"},{"code":"21922006204","type":"NDC"}],"standard_charges":[{"gross_charge":58.39,"discounted_cash":40.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155001001","type":"CDM"},{"code":"23155001001","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155002601","type":"CDM"},{"code":"23155002601","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155010201","type":"CDM"},{"code":"23155010201","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155011101","type":"CDM"},{"code":"23155011101","type":"NDC"}],"standard_charges":[{"gross_charge":10.14,"discounted_cash":7.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155011803","type":"CDM"},{"code":"23155011803","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155028801","type":"CDM"},{"code":"23155028801","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIKACIN SULFATE INJ 1 GM/4ML (250 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx23155029042","type":"CDM"},{"code":"J0278","type":"HCPCS"},{"code":"23155029042","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155029431","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"23155029431","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155029442","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"23155029442","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155031331","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"23155031331","type":"NDC"}],"standard_charges":[{"gross_charge":427.39,"discounted_cash":299.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155047332","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"23155047332","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155049731","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"23155049731","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx23155049742","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"23155049742","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155050001","type":"CDM"},{"code":"23155050001","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx23155062031","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"23155062031","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155085825","type":"CDM"},{"code":"23155085825","type":"NDC"}],"standard_charges":[{"gross_charge":13.71,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx23155085878","type":"CDM"},{"code":"23155085878","type":"NDC"}],"standard_charges":[{"gross_charge":12.47,"discounted_cash":8.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx23900001252","type":"CDM"},{"code":"23900001252","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208041105","type":"CDM"},{"code":"24208041105","type":"NDC"}],"standard_charges":[{"gross_charge":90.17,"discounted_cash":63.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208048610","type":"CDM"},{"code":"24208048610","type":"NDC"}],"standard_charges":[{"gross_charge":75.22,"discounted_cash":52.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCHOLINE CHLORIDE INTRAOCULAR FOR SOLN 20 MG (1:100)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24208053920","type":"CDM"},{"code":"24208053920","type":"NDC"}],"standard_charges":[{"gross_charge":157.88,"discounted_cash":110.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACITRACIN-POLYMYXIN B OPHTH OINT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208055555","type":"CDM"},{"code":"24208055555","type":"NDC"}],"standard_charges":[{"gross_charge":111.23,"discounted_cash":77.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GENTAMICIN SULFATE OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208058060","type":"CDM"},{"code":"24208058060","type":"NDC"}],"standard_charges":[{"gross_charge":146.13,"discounted_cash":102.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24208058559","type":"CDM"},{"code":"24208058559","type":"NDC"}],"standard_charges":[{"gross_charge":71.94,"discounted_cash":50.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-HC OTIC SUSP 3.5 MG/ML-10000 UNIT/ML-1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx24208063562","type":"CDM"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"gross_charge":178.5,"discounted_cash":124.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFACETAMIDE SODIUM OPHTH SOLN 10%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208067004","type":"CDM"},{"code":"24208067004","type":"NDC"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24208069760","type":"CDM"},{"code":"24208069760","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE OPHTH SOLN 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208072002","type":"CDM"},{"code":"24208072002","type":"NDC"}],"standard_charges":[{"gross_charge":176.28,"discounted_cash":123.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPARACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx24208073006","type":"CDM"},{"code":"24208073006","type":"NDC"}],"standard_charges":[{"gross_charge":144.45,"discounted_cash":101.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx24208073501","type":"CDM"},{"code":"24208073501","type":"NDC"}],"standard_charges":[{"gross_charge":83.61,"discounted_cash":58.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208079535","type":"CDM"},{"code":"24208079535","type":"NDC"}],"standard_charges":[{"gross_charge":88.36,"discounted_cash":61.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH SUSP 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx24208083060","type":"CDM"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"gross_charge":92.45,"discounted_cash":64.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx24208091019","type":"CDM"},{"code":"24208091019","type":"NDC"}],"standard_charges":[{"gross_charge":71.6,"discounted_cash":50.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx24208091055","type":"CDM"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"gross_charge":81.53,"discounted_cash":57.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERYTHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24338010203","type":"CDM"},{"code":"24338010203","type":"NDC"}],"standard_charges":[{"gross_charge":20.06,"discounted_cash":14.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 40 MG/200ML IN SODIUM CHLORIDE 0.83%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx24477032301","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"24477032301","type":"NDC"}],"standard_charges":[{"gross_charge":1163.71,"discounted_cash":814.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx24689079302","type":"CDM"},{"code":"24689079302","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETHACRYNATE SODIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25010021027","type":"CDM"},{"code":"J1807","type":"HCPCS"},{"code":"25010021027","type":"NDC"}],"standard_charges":[{"gross_charge":18757.55,"discounted_cash":13130.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETHACRYNIC ACID TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25010021515","type":"CDM"},{"code":"25010021515","type":"NDC"}],"standard_charges":[{"gross_charge":52.01,"discounted_cash":36.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021010010","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"25021010010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021010610","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"25021010610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021011382","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021011382","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021011487","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"25021011487","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 300 MG/2ML,CLINDAMYCIN PHOSPHATE INJ 600 MG/4ML,CLINDAMYCIN PHOSPHATE INJ 900 MG/6ML,CLINDAMYCIN PHOSPHATE INJ 9 GM/60ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021011504","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"25021011504","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021012720","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021012850","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"25021012850","type":"NDC"}],"standard_charges":[{"gross_charge":131.15,"discounted_cash":91.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021013281","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021013281","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML,LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML,LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021013282","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021013282","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx25021013283","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021013283","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021013610","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"25021013610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021013720","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"25021013720","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014010","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"25021014010","type":"NDC"}],"standard_charges":[{"gross_charge":328.16,"discounted_cash":229.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021014330","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"25021014330","type":"NDC"}],"standard_charges":[{"gross_charge":128.24,"discounted_cash":89.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021015010","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"25021015010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021015320","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"25021015320","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021015799","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"25021015799","type":"NDC"}],"standard_charges":[{"gross_charge":276.97,"discounted_cash":193.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021016530","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"25021016530","type":"NDC"}],"standard_charges":[{"gross_charge":135.54,"discounted_cash":94.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021018466","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018466","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021018482","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"25021018482","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021019110","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"25021019110","type":"NDC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":244.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021019111","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"25021019111","type":"NDC"}],"standard_charges":[{"gross_charge":349.05,"discounted_cash":244.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx25021019287","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"25021019287","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx25021030305","type":"CDM"},{"code":"25021030305","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx25021030884","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"25021030884","type":"NDC"}],"standard_charges":[{"gross_charge":933.51,"discounted_cash":653.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021031002","type":"CDM"},{"code":"25021031002","type":"NDC"}],"standard_charges":[{"gross_charge":1551.98,"discounted_cash":1086.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021031104","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"25021031104","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx25021031604","type":"CDM"},{"code":"25021031604","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021031905","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"25021031905","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021040010","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"25021040010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 200 MCG/ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx25021045405","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"25021045405","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DESMOPRESSIN ACETATE INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx25021046110","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"25021046110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 200 MCG/ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx25021046605","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"25021046605","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021046810","type":"CDM"},{"code":"J0650","type":"HCPCS"},{"code":"25021046810","type":"NDC"}],"standard_charges":[{"gross_charge":829.98,"discounted_cash":580.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021050002","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"25021050002","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021060820","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"25021060820","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021061281","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"25021061281","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021061551","type":"CDM"},{"code":"25021061551","type":"NDC"}],"standard_charges":[{"gross_charge":168.18,"discounted_cash":117.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021066205","type":"CDM"},{"code":"25021066205","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx25021068510","type":"CDM"},{"code":"25021068510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021077702","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"25021077702","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021079002","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"25021079002","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx25021079003","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"25021079003","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx25021080601","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"25021080601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx25021081230","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"25021081230","type":"NDC"}],"standard_charges":[{"gross_charge":302.41,"discounted_cash":211.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx25021082581","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021082581","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021082582","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021082582","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"Rx25021082583","type":"CDM"},{"code":"J1956","type":"HCPCS"},{"code":"25021082583","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 4 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021082667","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"25021082667","type":"NDC"}],"standard_charges":[{"gross_charge":353.34,"discounted_cash":247.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 4 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx25021082682","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"25021082682","type":"NDC"}],"standard_charges":[{"gross_charge":353.34,"discounted_cash":247.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx27241013909","type":"CDM"},{"code":"27241013909","type":"NDC"}],"standard_charges":[{"gross_charge":21.8,"discounted_cash":15.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx27437005057","type":"CDM"},{"code":"27437005057","type":"NDC"}],"standard_charges":[{"gross_charge":118.01,"discounted_cash":82.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVALBUTEROL TARTRATE INHAL AEROSOL 45 MCG/ACT (BASE EQUIV)","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx27437005601","type":"CDM"},{"code":"27437005601","type":"NDC"}],"standard_charges":[{"gross_charge":175.64,"discounted_cash":122.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCOD POLST-CHLORPHEN POLST ER SUSP 10-8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx27808008601","type":"CDM"},{"code":"27808008601","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29033002602","type":"CDM"},{"code":"29033002602","type":"NDC"}],"standard_charges":[{"gross_charge":10.54,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx29300041901","type":"CDM"},{"code":"29300041901","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722013130","type":"CDM"},{"code":"31722013130","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722030801","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"31722030801","type":"NDC"}],"standard_charges":[{"gross_charge":189.68,"discounted_cash":132.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722032901","type":"CDM"},{"code":"31722032901","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722053101","type":"CDM"},{"code":"31722053101","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722053401","type":"CDM"},{"code":"31722053401","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx31722063031","type":"CDM"},{"code":"31722063031","type":"NDC"}],"standard_charges":[{"gross_charge":14.64,"discounted_cash":10.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMCICLOVIR TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342002607","type":"CDM"},{"code":"33342002607","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342006310","type":"CDM"},{"code":"33342006310","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342008307","type":"CDM"},{"code":"33342008307","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342008407","type":"CDM"},{"code":"33342008407","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 5 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342009302","type":"CDM"},{"code":"33342009302","type":"NDC"}],"standard_charges":[{"gross_charge":13.22,"discounted_cash":9.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIZATRIPTAN BENZOATE ORAL DISINTEGRATING TAB 5 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342009341","type":"CDM"},{"code":"33342009341","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx33342015611","type":"CDM"},{"code":"33342015611","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VITAMIN E OIL","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx35046000264","type":"CDM"},{"code":"35046000264","type":"NDC"}],"standard_charges":[{"gross_charge":6.09,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERBUTALINE SULFATE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx35356036730","type":"CDM"},{"code":"35356036730","type":"NDC"}],"standard_charges":[{"gross_charge":13.32,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN 400 MG/200ML IN D5W","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx36000000924","type":"CDM"},{"code":"J0744","type":"HCPCS"},{"code":"36000000924","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000001225","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"36000001225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx36000003310","type":"CDM"},{"code":"36000003310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx36000028325","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"36000028325","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx36000032202","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"36000032202","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PSYLLIUM POWDER PACKET 51.7%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37000002410","type":"CDM"},{"code":"37000002410","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PSYLLIUM POWDER PACKET 51.7%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37000025445","type":"CDM"},{"code":"37000025445","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PSYLLIUM WAFER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37000074091","type":"CDM"},{"code":"37000074091","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SIMETHICONE SUSP 40 MG/0.6ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx37205011910","type":"CDM"},{"code":"37205011910","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 125 MCG (5000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37205024678","type":"CDM"},{"code":"37205024678","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37205036174","type":"CDM"},{"code":"37205036174","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-5 MCG(200 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37864008289","type":"CDM"},{"code":"37864008289","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx37864090599","type":"CDM"},{"code":"37864090599","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.25%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx39328006325","type":"CDM"},{"code":"39328006325","type":"NDC"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":8.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM HYPOCHLORITE SOLN 0.125%","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"Rx39328006412","type":"CDM"},{"code":"39328006412","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":9.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAZOLAMIDE SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx39822019007","type":"CDM"},{"code":"J1120","type":"HCPCS"},{"code":"39822019007","type":"NDC"}],"standard_charges":[{"gross_charge":464.28,"discounted_cash":325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx39822100001","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"39822100001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOLIC ACID INJ 5 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx39822110001","type":"CDM"},{"code":"J1808","type":"HCPCS"},{"code":"39822110001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx39822400001","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"39822400001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx39822420001","type":"CDM"},{"code":"39822420001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx39822420002","type":"CDM"},{"code":"39822420002","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROBIOTIC PRODUCT - CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx40985021339","type":"CDM"},{"code":"40985021339","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx40985022368","type":"CDM"},{"code":"40985022368","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 125 MCG (5000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx40985027288","type":"CDM"},{"code":"40985027288","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VITAMINS A & D OINT","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx41100081122","type":"CDM"},{"code":"41100081122","type":"NDC"}],"standard_charges":[{"gross_charge":3.35,"discounted_cash":2.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VITAMINS A & D OINT","drug_information":{"unit":113.0,"type":"GM"},"code_information":[{"code":"Rx41100081124","type":"CDM"},{"code":"41100081124","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":3.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx41100081127","type":"CDM"},{"code":"41100081127","type":"NDC"}],"standard_charges":[{"gross_charge":8.08,"discounted_cash":5.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL POWDER 17 GM/SCOOP","drug_information":{"unit":238.0,"type":"GM"},"code_information":[{"code":"Rx41100082073","type":"CDM"},{"code":"41100082073","type":"NDC"}],"standard_charges":[{"gross_charge":10.07,"discounted_cash":7.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MENTHOL-METHYL SALICYLATE OINTMENT","drug_information":{"unit":99.2,"type":"GM"},"code_information":[{"code":"Rx41167000879","type":"CDM"},{"code":"41167000879","type":"NDC"}],"standard_charges":[{"gross_charge":4.91,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx41167005743","type":"CDM"},{"code":"41167005743","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx42023010401","type":"CDM"},{"code":"42023010401","type":"NDC"}],"standard_charges":[{"gross_charge":160.46,"discounted_cash":112.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx42023010405","type":"CDM"},{"code":"42023010405","type":"NDC"}],"standard_charges":[{"gross_charge":125.02,"discounted_cash":87.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHOHEXITAL SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023010501","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"42023010501","type":"NDC"}],"standard_charges":[{"gross_charge":1217.5,"discounted_cash":852.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023011510","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"42023011510","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42023011625","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"42023011625","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx42023014625","type":"CDM"},{"code":"42023014625","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETHACRYNATE SODIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023015701","type":"CDM"},{"code":"J1807","type":"HCPCS"},{"code":"42023015701","type":"NDC"}],"standard_charges":[{"gross_charge":2083.04,"discounted_cash":1458.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx42023015901","type":"CDM"},{"code":"42023015901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx42023015925","type":"CDM"},{"code":"42023015925","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx42023016401","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"42023016401","type":"NDC"}],"standard_charges":[{"gross_charge":293.8,"discounted_cash":205.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx42023016425","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"42023016425","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx42023016801","type":"CDM"},{"code":"42023016801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx42023018701","type":"CDM"},{"code":"42023018701","type":"NDC"}],"standard_charges":[{"gross_charge":415.06,"discounted_cash":290.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023023001","type":"CDM"},{"code":"J2247","type":"HCPCS"},{"code":"42023023001","type":"NDC"}],"standard_charges":[{"gross_charge":670.74,"discounted_cash":469.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42023023010","type":"CDM"},{"code":"J2247","type":"HCPCS"},{"code":"42023023010","type":"NDC"}],"standard_charges":[{"gross_charge":495.88,"discounted_cash":347.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42043014001","type":"CDM"},{"code":"42043014001","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx42043014338","type":"CDM"},{"code":"42043014338","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THYROID TAB 60 MG (1 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192033001","type":"CDM"},{"code":"42192033001","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB DISINT 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42192033801","type":"CDM"},{"code":"42192033801","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42291026601","type":"CDM"},{"code":"42291026601","type":"NDC"}],"standard_charges":[{"gross_charge":12.33,"discounted_cash":8.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 88 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292003801","type":"CDM"},{"code":"42292003801","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42292003901","type":"CDM"},{"code":"42292003901","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EMTRICITABINE-TENOFOVIR DISOPROXIL FUMARATE TAB 200-300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42385095330","type":"CDM"},{"code":"42385095330","type":"NDC"}],"standard_charges":[{"gross_charge":11.24,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42494041501","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041501","type":"NDC"}],"standard_charges":[{"gross_charge":283.35,"discounted_cash":198.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42494041503","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041503","type":"NDC"}],"standard_charges":[{"gross_charge":308.86,"discounted_cash":216.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 65 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx42494041525","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041525","type":"NDC"}],"standard_charges":[{"gross_charge":155.58,"discounted_cash":108.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.384615384615385,"type":"ML"},"code_information":[{"code":"Rx42494041601","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041601","type":"NDC"}],"standard_charges":[{"gross_charge":336.05,"discounted_cash":235.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOBARBITAL SODIUM INJ 130 MG/ML","drug_information":{"unit":0.384615384615385,"type":"ML"},"code_information":[{"code":"Rx42494041625","type":"CDM"},{"code":"J2560","type":"HCPCS"},{"code":"42494041625","type":"NDC"}],"standard_charges":[{"gross_charge":152.09,"discounted_cash":106.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx42494044805","type":"CDM"},{"code":"42494044805","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx42571013725","type":"CDM"},{"code":"42571013725","type":"NDC"}],"standard_charges":[{"gross_charge":74.27,"discounted_cash":51.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx42571013726","type":"CDM"},{"code":"42571013726","type":"NDC"}],"standard_charges":[{"gross_charge":90.92,"discounted_cash":63.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx42702010215","type":"CDM"},{"code":"42702010215","type":"NDC"}],"standard_charges":[{"gross_charge":289.94,"discounted_cash":202.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx42702010305","type":"CDM"},{"code":"42702010305","type":"NDC"}],"standard_charges":[{"gross_charge":156.15,"discounted_cash":109.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETHACRYNIC ACID TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42799040501","type":"CDM"},{"code":"42799040501","type":"NDC"}],"standard_charges":[{"gross_charge":14.4,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEPERIDINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806005030","type":"CDM"},{"code":"42806005030","type":"NDC"}],"standard_charges":[{"gross_charge":75.45,"discounted_cash":52.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx42806015033","type":"CDM"},{"code":"42806015033","type":"NDC"}],"standard_charges":[{"gross_charge":15.19,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42806071405","type":"CDM"},{"code":"42806071405","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858000110","type":"CDM"},{"code":"42858000110","type":"NDC"}],"standard_charges":[{"gross_charge":12.31,"discounted_cash":8.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858030101","type":"CDM"},{"code":"42858030101","type":"NDC"}],"standard_charges":[{"gross_charge":11.94,"discounted_cash":8.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858030125","type":"CDM"},{"code":"42858030125","type":"NDC"}],"standard_charges":[{"gross_charge":11.82,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858030225","type":"CDM"},{"code":"42858030225","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE TAB ER 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx42858080401","type":"CDM"},{"code":"42858080401","type":"NDC"}],"standard_charges":[{"gross_charge":13.22,"discounted_cash":9.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx43066000801","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"43066000801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx43066000810","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"43066000810","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 40 MG/200ML IN SODIUM CHLORIDE 0.83%","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx43066001610","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"43066001610","type":"NDC"}],"standard_charges":[{"gross_charge":888.76,"discounted_cash":622.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL IN DEXTROSE 4.21% IV SOLN 150 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43066015010","type":"CDM"},{"code":"J0283","type":"HCPCS"},{"code":"43066015010","type":"NDC"}],"standard_charges":[{"gross_charge":208.3,"discounted_cash":145.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL IN DEXTROSE 4.14% IV SOLN 360 MG/200ML","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"Rx43066036020","type":"CDM"},{"code":"J0283","type":"HCPCS"},{"code":"43066036020","type":"NDC"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx43066099701","type":"CDM"},{"code":"43066099701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx43066099710","type":"CDM"},{"code":"43066099710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43199001101","type":"CDM"},{"code":"43199001101","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"B-COMPLEX VITAMIN TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43292055540","type":"CDM"},{"code":"43292055540","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PEG 3350-KCL-NA BICARB-NACL-NA SULFATE FOR SOLN 236 GM","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"Rx43386009019","type":"CDM"},{"code":"43386009019","type":"NDC"}],"standard_charges":[{"gross_charge":40.04,"discounted_cash":28.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE TAB 0.2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386014028","type":"CDM"},{"code":"43386014028","type":"NDC"}],"standard_charges":[{"gross_charge":103.28,"discounted_cash":72.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386016106","type":"CDM"},{"code":"43386016106","type":"NDC"}],"standard_charges":[{"gross_charge":11.78,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIMETHOPRIM TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386033001","type":"CDM"},{"code":"43386033001","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NIFEDIPINE CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386044024","type":"CDM"},{"code":"43386044024","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCYTOSINE CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43386077001","type":"CDM"},{"code":"43386077001","type":"NDC"}],"standard_charges":[{"gross_charge":44.9,"discounted_cash":31.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43478090088","type":"CDM"},{"code":"43478090088","type":"NDC"}],"standard_charges":[{"gross_charge":13.03,"discounted_cash":9.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL CAP ER 24HR 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43478090188","type":"CDM"},{"code":"43478090188","type":"NDC"}],"standard_charges":[{"gross_charge":13.48,"discounted_cash":9.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547026810","type":"CDM"},{"code":"43547026810","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547027010","type":"CDM"},{"code":"43547027010","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROPINIROLE HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547027410","type":"CDM"},{"code":"43547027410","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547036809","type":"CDM"},{"code":"43547036809","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040110","type":"CDM"},{"code":"43547040110","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040210","type":"CDM"},{"code":"43547040210","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040310","type":"CDM"},{"code":"43547040310","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43547040610","type":"CDM"},{"code":"43547040610","type":"NDC"}],"standard_charges":[{"gross_charge":11.57,"discounted_cash":8.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx43547053001","type":"CDM"},{"code":"43547053001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx43547053010","type":"CDM"},{"code":"43547053010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43547054401","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"43547054401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.4 MG/2ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43547054425","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"43547054425","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43547063901","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"43547063901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43547063925","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"43547063925","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598005011","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"43598005011","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598008611","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"43598008611","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598008658","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"43598008658","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx43598010610","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"43598010610","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx43598010611","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"43598010611","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 50 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598014111","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"43598014111","type":"NDC"}],"standard_charges":[{"gross_charge":104.25,"discounted_cash":72.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORPROMAZINE HCL INJ 50 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598014125","type":"CDM"},{"code":"J3230","type":"HCPCS"},{"code":"43598014125","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598016911","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"43598016911","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENALAPRILAT IV SOLN 1.25 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx43598016958","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"43598016958","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx43598040511","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"43598040511","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx43598040516","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"43598040516","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044670","type":"CDM"},{"code":"43598044670","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044671","type":"CDM"},{"code":"43598044671","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044771","type":"CDM"},{"code":"43598044771","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044828","type":"CDM"},{"code":"43598044828","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598044871","type":"CDM"},{"code":"43598044871","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598057901","type":"CDM"},{"code":"43598057901","type":"NDC"}],"standard_charges":[{"gross_charge":17.66,"discounted_cash":12.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598058201","type":"CDM"},{"code":"43598058201","type":"NDC"}],"standard_charges":[{"gross_charge":22.51,"discounted_cash":15.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598058230","type":"CDM"},{"code":"43598058230","type":"NDC"}],"standard_charges":[{"gross_charge":17.05,"discounted_cash":11.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598063610","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"43598063610","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598063652","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"43598063652","type":"NDC"}],"standard_charges":[{"gross_charge":291.62,"discounted_cash":204.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598063710","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"43598063710","type":"NDC"}],"standard_charges":[{"gross_charge":151.21,"discounted_cash":105.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx43598063752","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"43598063752","type":"NDC"}],"standard_charges":[{"gross_charge":382.66,"discounted_cash":267.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SACUBITRIL-VALSARTAN TAB 24-26 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598064360","type":"CDM"},{"code":"43598064360","type":"NDC"}],"standard_charges":[{"gross_charge":11.87,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43598069811","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"43598069811","type":"NDC"}],"standard_charges":[{"gross_charge":275.62,"discounted_cash":192.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx43598069858","type":"CDM"},{"code":"J0675","type":"HCPCS"},{"code":"43598069858","type":"NDC"}],"standard_charges":[{"gross_charge":289.8,"discounted_cash":202.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598072101","type":"CDM"},{"code":"43598072101","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx43598075010","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"43598075010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx43598075011","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"43598075011","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598090111","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"43598090111","type":"NDC"}],"standard_charges":[{"gross_charge":655.27,"discounted_cash":458.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43598090158","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"43598090158","type":"NDC"}],"standard_charges":[{"gross_charge":369.54,"discounted_cash":258.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INDAPAMIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43975030410","type":"CDM"},{"code":"43975030410","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43975032203","type":"CDM"},{"code":"43975032203","type":"NDC"}],"standard_charges":[{"gross_charge":10.94,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx43975032209","type":"CDM"},{"code":"43975032209","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567021110","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"44567021110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567022210","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"44567022210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTAZIDIME FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567023610","type":"CDM"},{"code":"J0713","type":"HCPCS"},{"code":"44567023610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567024525","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"44567024525","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567024625","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"44567024625","type":"NDC"}],"standard_charges":[{"gross_charge":103.47,"discounted_cash":72.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567031110","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567041024","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"44567041024","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44567042024","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"44567042024","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM 1 MG/ML PCA SYRINGE,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.9% IV SOLN,MIDAZOLAM HCL 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.8% IV SOLN,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.8% IV SOLN,MIDAZOLAM IV SOLN 100 MG/100ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 50 MG/50ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 30 MG/30ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM IV SOLN PREFILLED SYRINGE 25 MG/25ML,MIDAZOLAM IV SOLN 50 MG/50ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.8% PF IV SOLUTION,MIDAZOLAM HCL 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM HCL 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.8% PF IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567061101","type":"CDM"},{"code":"J2251","type":"HCPCS"},{"code":"44567061101","type":"NDC"}],"standard_charges":[{"gross_charge":419.69,"discounted_cash":293.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM 1 MG/ML PCA SYRINGE,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.9% IV SOLN,MIDAZOLAM HCL 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM HCL 50 MG/50ML-SODIUM CHLORIDE 0.8% IV SOLN,MIDAZOLAM HCL 100 MG/100ML IN NACL 0.8% IV SOLN,MIDAZOLAM IV SOLN 100 MG/100ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 50 MG/50ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 30 MG/30ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% IV SOLN,MIDAZOLAM 55 MG/55ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM IV SOLN PREFILLED SYRINGE 25 MG/25ML,MIDAZOLAM IV SOLN 50 MG/50ML,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.8% PF IV SOLUTION,MIDAZOLAM HCL 30 MG/30ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM HCL 50 MG/50ML-NACL 0.9% IV SOLN PREFILLED SYRINGE,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 100 MG/100ML-SODIUM CHLORIDE 0.9% PF IV SOLN,MIDAZOLAM 50 MG/50ML-SODIUM CHLORIDE 0.8% PF IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567061110","type":"CDM"},{"code":"J2251","type":"HCPCS"},{"code":"44567061110","type":"NDC"}],"standard_charges":[{"gross_charge":223.73,"discounted_cash":156.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 1 GM/50ML-0.675% (20 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44567062001","type":"CDM"},{"code":"J0613","type":"HCPCS"},{"code":"44567062001","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 1 GM/50ML-0.675% (20 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx44567062024","type":"CDM"},{"code":"J0613","type":"HCPCS"},{"code":"44567062024","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL-SODIUM CHLORIDE IV SOLN 100 MG/100ML-0.72%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567066201","type":"CDM"},{"code":"44567066201","type":"NDC"}],"standard_charges":[{"gross_charge":381.12,"discounted_cash":266.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL-SODIUM CHLORIDE IV SOLN 100 MG/100ML-0.72%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx44567066210","type":"CDM"},{"code":"44567066210","type":"NDC"}],"standard_charges":[{"gross_charge":311.68,"discounted_cash":218.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx44567070510","type":"CDM"},{"code":"J0743","type":"HCPCS"},{"code":"44567070510","type":"NDC"}],"standard_charges":[{"gross_charge":145.73,"discounted_cash":102.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LANOLIN CREAM","drug_information":{"unit":7.0,"type":"GM"},"code_information":[{"code":"Rx44677010202","type":"CDM"},{"code":"44677010202","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE PATCH 4%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45611000938","type":"CDM"},{"code":"45611000938","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIBUCAINE PERIANAL OINTMENT 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx45802005003","type":"CDM"},{"code":"45802005003","type":"NDC"}],"standard_charges":[{"gross_charge":6.18,"discounted_cash":4.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN CREAM 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx45802005935","type":"CDM"},{"code":"45802005935","type":"NDC"}],"standard_charges":[{"gross_charge":61.89,"discounted_cash":43.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802006170","type":"CDM"},{"code":"45802006170","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":8.5,"type":"GM"},"code_information":[{"code":"Rx45802008801","type":"CDM"},{"code":"45802008801","type":"NDC"}],"standard_charges":[{"gross_charge":145.52,"discounted_cash":101.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MESALAMINE ENEMA 4 GM","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"Rx45802009851","type":"CDM"},{"code":"45802009851","type":"NDC"}],"standard_charges":[{"gross_charge":27.28,"discounted_cash":19.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":22.0,"type":"GM"},"code_information":[{"code":"Rx45802011222","type":"CDM"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"gross_charge":75.13,"discounted_cash":52.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802014370","type":"CDM"},{"code":"45802014370","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VITAMINS A & D OINT","drug_information":{"unit":113.0,"type":"GM"},"code_information":[{"code":"Rx45802039504","type":"CDM"},{"code":"45802039504","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROMETHORPHAN POLISTIREX EXTENDED RELEASE SUSP 30 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx45802043321","type":"CDM"},{"code":"45802043321","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx45802043803","type":"CDM"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOCONAZOLE SHAMPOO 2%","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx45802046564","type":"CDM"},{"code":"45802046564","type":"NDC"}],"standard_charges":[{"gross_charge":109.58,"discounted_cash":76.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTIC ACID (AMMONIUM LACTATE) LOTION 12%","drug_information":{"unit":227.0,"type":"GM"},"code_information":[{"code":"Rx45802052555","type":"CDM"},{"code":"45802052555","type":"NDC"}],"standard_charges":[{"gross_charge":7.49,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802058001","type":"CDM"},{"code":"45802058001","type":"NDC"}],"standard_charges":[{"gross_charge":26.64,"discounted_cash":18.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802073000","type":"CDM"},{"code":"45802073000","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802073030","type":"CDM"},{"code":"45802073030","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802073032","type":"CDM"},{"code":"45802073032","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802073200","type":"CDM"},{"code":"45802073200","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802073230","type":"CDM"},{"code":"45802073230","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL NASAL SPRAY 4 MG/0.1ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45802081184","type":"CDM"},{"code":"45802081184","type":"NDC"}],"standard_charges":[{"gross_charge":49.53,"discounted_cash":34.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx45802095301","type":"CDM"},{"code":"45802095301","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML,LACTULOSE (ENCEPHALOPATHY) SOLUTION 10 GM/15ML","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx45963043963","type":"CDM"},{"code":"45963043963","type":"NDC"}],"standard_charges":[{"gross_charge":20.77,"discounted_cash":14.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML,LACTULOSE (ENCEPHALOPATHY) SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx45963043963","type":"CDM"},{"code":"45963043963","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx45963067611","type":"CDM"},{"code":"45963067611","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SORBITOL SOLUTION (BULK)","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx46287050001","type":"CDM"},{"code":"46287050001","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SIMETHICONE SUSP 40 MG/0.6ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx46287050630","type":"CDM"},{"code":"46287050630","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":4.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MINERAL OIL-HYDROPHILIC PETROLATUM OINTMENT","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx46287050816","type":"CDM"},{"code":"46287050816","type":"NDC"}],"standard_charges":[{"gross_charge":57.2,"discounted_cash":40.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE PATCH 4%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx46581083006","type":"CDM"},{"code":"46581083006","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOFETILIDE CAP 250 MCG (0.25 MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335006286","type":"CDM"},{"code":"47335006286","type":"NDC"}],"standard_charges":[{"gross_charge":12.87,"discounted_cash":9.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BICALUTAMIDE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335048583","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"47335048583","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47335090488","type":"CDM"},{"code":"47335090488","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx47335099201","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"47335099201","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE IV SOLN 500 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx47335099301","type":"CDM"},{"code":"J1836","type":"HCPCS"},{"code":"47335099301","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47682022335","type":"CDM"},{"code":"47682022335","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781001101","type":"CDM"},{"code":"47781001101","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB DISINT 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781001201","type":"CDM"},{"code":"47781001201","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781019601","type":"CDM"},{"code":"47781019601","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":8.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781020604","type":"CDM"},{"code":"47781020604","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESTRADIOL TD PATCH WEEKLY 0.05 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781020611","type":"CDM"},{"code":"47781020611","type":"NDC"}],"standard_charges":[{"gross_charge":38.28,"discounted_cash":26.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781030301","type":"CDM"},{"code":"47781030301","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035503","type":"CDM"},{"code":"47781035503","type":"NDC"}],"standard_charges":[{"gross_charge":15.41,"discounted_cash":10.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 2-0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035511","type":"CDM"},{"code":"47781035511","type":"NDC"}],"standard_charges":[{"gross_charge":14.79,"discounted_cash":10.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 4-1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035603","type":"CDM"},{"code":"J0573","type":"HCPCS"},{"code":"47781035603","type":"NDC"}],"standard_charges":[{"gross_charge":18.47,"discounted_cash":12.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 4-1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035611","type":"CDM"},{"code":"J0573","type":"HCPCS"},{"code":"47781035611","type":"NDC"}],"standard_charges":[{"gross_charge":17.73,"discounted_cash":12.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035703","type":"CDM"},{"code":"47781035703","type":"NDC"}],"standard_charges":[{"gross_charge":16.43,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL SL FILM 8-2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781035711","type":"CDM"},{"code":"47781035711","type":"NDC"}],"standard_charges":[{"gross_charge":16.83,"discounted_cash":11.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx47781038426","type":"CDM"},{"code":"47781038426","type":"NDC"}],"standard_charges":[{"gross_charge":46.44,"discounted_cash":32.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042411","type":"CDM"},{"code":"47781042411","type":"NDC"}],"standard_charges":[{"gross_charge":23.95,"discounted_cash":16.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042447","type":"CDM"},{"code":"47781042447","type":"NDC"}],"standard_charges":[{"gross_charge":21.25,"discounted_cash":14.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042611","type":"CDM"},{"code":"47781042611","type":"NDC"}],"standard_charges":[{"gross_charge":33.58,"discounted_cash":23.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781042647","type":"CDM"},{"code":"47781042647","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":24.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781046813","type":"CDM"},{"code":"47781046813","type":"NDC"}],"standard_charges":[{"gross_charge":26.16,"discounted_cash":18.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781047013","type":"CDM"},{"code":"47781047013","type":"NDC"}],"standard_charges":[{"gross_charge":27.6,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx47781058468","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"47781058468","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx47781058629","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"47781058629","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx47781058922","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"47781058922","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781059707","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"47781059707","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx47781059807","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"47781059807","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx48102004711","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"48102004711","type":"NDC"}],"standard_charges":[{"gross_charge":11.73,"discounted_cash":8.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx48433010401","type":"CDM"},{"code":"48433010401","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx48433012901","type":"CDM"},{"code":"48433012901","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MINERAL OIL","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx48433020230","type":"CDM"},{"code":"48433020230","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ARTIFICIAL SALIVA - SOLUTION","drug_information":{"unit":44.3,"type":"ML"},"code_information":[{"code":"Rx48582000155","type":"CDM"},{"code":"48582000155","type":"NDC"}],"standard_charges":[{"gross_charge":7.13,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTOBACILLUS RHAMNOSUS (GG) CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49100036374","type":"CDM"},{"code":"49100036374","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTOBACILLUS-INULIN CAP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49100040009","type":"CDM"},{"code":"49100040009","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281021515","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"gross_charge":111.88,"discounted_cash":78.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281021558","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"49281021558","type":"NDC"}],"standard_charges":[{"gross_charge":111.88,"discounted_cash":78.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx49281021588","type":"CDM"},{"code":"90714","type":"HCPCS"},{"code":"49281021588","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RABIES VIRUS VACCINE, HDC FOR INJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49281025051","type":"CDM"},{"code":"90675","type":"HCPCS"},{"code":"49281025051","type":"NDC"}],"standard_charges":[{"gross_charge":1230.65,"discounted_cash":861.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RABIES VIRUS VACCINE, HDC FOR INJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49281025251","type":"CDM"},{"code":"90675","type":"HCPCS"},{"code":"49281025251","type":"NDC"}],"standard_charges":[{"gross_charge":1652.52,"discounted_cash":1156.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TUBERCULIN PPD INJ 5 UNIT/0.1ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx49281075221","type":"CDM"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"gross_charge":168.54,"discounted_cash":117.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49348057208","type":"CDM"},{"code":"49348057208","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM CITRATE SOLN","drug_information":{"unit":296.0,"type":"ML"},"code_information":[{"code":"Rx49580032910","type":"CDM"},{"code":"49580032910","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49730011130","type":"CDM"},{"code":"49730011130","type":"NDC"}],"standard_charges":[{"gross_charge":10.82,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49781014214","type":"CDM"},{"code":"49781014214","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMIPRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884005501","type":"CDM"},{"code":"49884005501","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT","drug_information":{"unit":3.7,"type":"ML"},"code_information":[{"code":"Rx49884016111","type":"CDM"},{"code":"49884016111","type":"NDC"}],"standard_charges":[{"gross_charge":180.23,"discounted_cash":126.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCOD POLST-CHLORPHEN POLST ER SUSP 10-8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx49884023505","type":"CDM"},{"code":"49884023505","type":"NDC"}],"standard_charges":[{"gross_charge":15.94,"discounted_cash":11.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884032052","type":"CDM"},{"code":"49884032052","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884032152","type":"CDM"},{"code":"49884032152","type":"NDC"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":8.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYUREA CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49884072401","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"49884072401","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MECLIZINE HCL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx49999008730","type":"CDM"},{"code":"49999008730","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYMETAZOLINE HCL NASAL SOLN 0.05%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx50024043100","type":"CDM"},{"code":"50024043100","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111033401","type":"CDM"},{"code":"50111033401","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111043301","type":"CDM"},{"code":"50111043301","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111056001","type":"CDM"},{"code":"50111056001","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111091701","type":"CDM"},{"code":"50111091701","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TORSEMIDE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50111091801","type":"CDM"},{"code":"50111091801","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE CAP 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228014601","type":"CDM"},{"code":"50228014601","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228017901","type":"CDM"},{"code":"50228017901","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETHACRYNIC ACID TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228033410","type":"CDM"},{"code":"50228033410","type":"NDC"}],"standard_charges":[{"gross_charge":12.22,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228037990","type":"CDM"},{"code":"50228037990","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50228048201","type":"CDM"},{"code":"50228048201","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALTEPLASE FOR INJ 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242004164","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242004164","type":"NDC"}],"standard_charges":[{"gross_charge":2195.25,"discounted_cash":1536.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALTEPLASE FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242004413","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242004413","type":"NDC"}],"standard_charges":[{"gross_charge":16460.88,"discounted_cash":11522.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALTEPLASE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242008527","type":"CDM"},{"code":"J2997","type":"HCPCS"},{"code":"50242008527","type":"NDC"}],"standard_charges":[{"gross_charge":32921.72,"discounted_cash":23045.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TENECTEPLASE FOR IV SOLN KIT 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242012001","type":"CDM"},{"code":"J3101","type":"HCPCS"},{"code":"50242012001","type":"NDC"}],"standard_charges":[{"gross_charge":22939.1,"discounted_cash":16057.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TENECTEPLASE FOR IV SOLN KIT 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242012047","type":"CDM"},{"code":"J3101","type":"HCPCS"},{"code":"50242012047","type":"NDC"}],"standard_charges":[{"gross_charge":31039.66,"discounted_cash":21727.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOCILIZUMAB IV INJ 400 MG/20ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx50242013701","type":"CDM"},{"code":"J3262","type":"HCPCS"},{"code":"50242013701","type":"NDC"}],"standard_charges":[{"gross_charge":9932.02,"discounted_cash":6952.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TENECTEPLASE FOR IV SOLN KIT 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50242017601","type":"CDM"},{"code":"J3101","type":"HCPCS"},{"code":"50242017601","type":"NDC"}],"standard_charges":[{"gross_charge":31039.66,"discounted_cash":21727.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268003711","type":"CDM"},{"code":"50268003711","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268003715","type":"CDM"},{"code":"50268003715","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268005411","type":"CDM"},{"code":"50268005411","type":"NDC"}],"standard_charges":[{"gross_charge":13.45,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268005415","type":"CDM"},{"code":"50268005415","type":"NDC"}],"standard_charges":[{"gross_charge":13.7,"discounted_cash":9.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268006015","type":"CDM"},{"code":"50268006015","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268006111","type":"CDM"},{"code":"50268006111","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268006115","type":"CDM"},{"code":"50268006115","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ANASTROZOLE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268007511","type":"CDM"},{"code":"50268007511","type":"NDC"}],"standard_charges":[{"gross_charge":11.33,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268009811","type":"CDM"},{"code":"50268009811","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268009815","type":"CDM"},{"code":"50268009815","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268010611","type":"CDM"},{"code":"50268010611","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268010615","type":"CDM"},{"code":"50268010615","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BETHANECHOL CHLORIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268011315","type":"CDM"},{"code":"50268011315","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268013111","type":"CDM"},{"code":"50268013111","type":"NDC"}],"standard_charges":[{"gross_charge":11.96,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268013115","type":"CDM"},{"code":"50268013115","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268014211","type":"CDM"},{"code":"50268014211","type":"NDC"}],"standard_charges":[{"gross_charge":11.51,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268014215","type":"CDM"},{"code":"50268014215","type":"NDC"}],"standard_charges":[{"gross_charge":11.48,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268014811","type":"CDM"},{"code":"50268014811","type":"NDC"}],"standard_charges":[{"gross_charge":11.61,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268014815","type":"CDM"},{"code":"50268014815","type":"NDC"}],"standard_charges":[{"gross_charge":12.53,"discounted_cash":8.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268015111","type":"CDM"},{"code":"50268015111","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268015115","type":"CDM"},{"code":"50268015115","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268015211","type":"CDM"},{"code":"50268015211","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268015215","type":"CDM"},{"code":"50268015215","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016811","type":"CDM"},{"code":"50268016811","type":"NDC"}],"standard_charges":[{"gross_charge":11.47,"discounted_cash":8.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268016815","type":"CDM"},{"code":"50268016815","type":"NDC"}],"standard_charges":[{"gross_charge":11.23,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CILOSTAZOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268017711","type":"CDM"},{"code":"50268017711","type":"NDC"}],"standard_charges":[{"gross_charge":11.87,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CILOSTAZOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268017715","type":"CDM"},{"code":"50268017715","type":"NDC"}],"standard_charges":[{"gross_charge":11.39,"discounted_cash":7.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268018915","type":"CDM"},{"code":"50268018915","type":"NDC"}],"standard_charges":[{"gross_charge":11.23,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268019111","type":"CDM"},{"code":"50268019111","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268019115","type":"CDM"},{"code":"50268019115","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268019911","type":"CDM"},{"code":"50268019911","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268019915","type":"CDM"},{"code":"50268019915","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268025811","type":"CDM"},{"code":"50268025811","type":"NDC"}],"standard_charges":[{"gross_charge":11.29,"discounted_cash":7.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268026815","type":"CDM"},{"code":"50268026815","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268027911","type":"CDM"},{"code":"50268027911","type":"NDC"}],"standard_charges":[{"gross_charge":12.47,"discounted_cash":8.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268029711","type":"CDM"},{"code":"50268029711","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268029715","type":"CDM"},{"code":"50268029715","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268029811","type":"CDM"},{"code":"50268029811","type":"NDC"}],"standard_charges":[{"gross_charge":18.04,"discounted_cash":12.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268029812","type":"CDM"},{"code":"50268029812","type":"NDC"}],"standard_charges":[{"gross_charge":18.34,"discounted_cash":12.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268030311","type":"CDM"},{"code":"50268030311","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268030315","type":"CDM"},{"code":"50268030315","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031211","type":"CDM"},{"code":"50268031211","type":"NDC"}],"standard_charges":[{"gross_charge":12.32,"discounted_cash":8.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031311","type":"CDM"},{"code":"50268031311","type":"NDC"}],"standard_charges":[{"gross_charge":12.17,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268031315","type":"CDM"},{"code":"50268031315","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268032011","type":"CDM"},{"code":"50268032011","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268032015","type":"CDM"},{"code":"50268032015","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268032315","type":"CDM"},{"code":"50268032315","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268033011","type":"CDM"},{"code":"50268033011","type":"NDC"}],"standard_charges":[{"gross_charge":10.91,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268033711","type":"CDM"},{"code":"50268033711","type":"NDC"}],"standard_charges":[{"gross_charge":11.82,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268033715","type":"CDM"},{"code":"50268033715","type":"NDC"}],"standard_charges":[{"gross_charge":12.28,"discounted_cash":8.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035011","type":"CDM"},{"code":"50268035011","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035015","type":"CDM"},{"code":"50268035015","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035911","type":"CDM"},{"code":"50268035911","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268035915","type":"CDM"},{"code":"50268035915","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268039811","type":"CDM"},{"code":"50268039811","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268039850","type":"CDM"},{"code":"50268039850","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040111","type":"CDM"},{"code":"50268040111","type":"NDC"}],"standard_charges":[{"gross_charge":11.94,"discounted_cash":8.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040211","type":"CDM"},{"code":"50268040211","type":"NDC"}],"standard_charges":[{"gross_charge":11.92,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040215","type":"CDM"},{"code":"50268040215","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040511","type":"CDM"},{"code":"50268040511","type":"NDC"}],"standard_charges":[{"gross_charge":12.76,"discounted_cash":8.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268040515","type":"CDM"},{"code":"50268040515","type":"NDC"}],"standard_charges":[{"gross_charge":12.8,"discounted_cash":8.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268041211","type":"CDM"},{"code":"50268041211","type":"NDC"}],"standard_charges":[{"gross_charge":12.13,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268043011","type":"CDM"},{"code":"50268043011","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268043015","type":"CDM"},{"code":"50268043015","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268048811","type":"CDM"},{"code":"50268048811","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268048815","type":"CDM"},{"code":"50268048815","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268048911","type":"CDM"},{"code":"50268048911","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268048915","type":"CDM"},{"code":"50268048915","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268050411","type":"CDM"},{"code":"50268050411","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268050415","type":"CDM"},{"code":"50268050415","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268050511","type":"CDM"},{"code":"50268050511","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268050515","type":"CDM"},{"code":"50268050515","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052411","type":"CDM"},{"code":"50268052411","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052511","type":"CDM"},{"code":"50268052511","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052811","type":"CDM"},{"code":"50268052811","type":"NDC"}],"standard_charges":[{"gross_charge":13.33,"discounted_cash":9.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268052815","type":"CDM"},{"code":"50268052815","type":"NDC"}],"standard_charges":[{"gross_charge":14.02,"discounted_cash":9.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268053411","type":"CDM"},{"code":"50268053411","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268053415","type":"CDM"},{"code":"50268053415","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METRONIDAZOLE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268053515","type":"CDM"},{"code":"50268053515","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268054111","type":"CDM"},{"code":"50268054111","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268055011","type":"CDM"},{"code":"50268055011","type":"NDC"}],"standard_charges":[{"gross_charge":11.03,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268056211","type":"CDM"},{"code":"50268056211","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDODRINE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268056215","type":"CDM"},{"code":"50268056215","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx50268056811","type":"CDM"},{"code":"50268056811","type":"NDC"}],"standard_charges":[{"gross_charge":57.32,"discounted_cash":40.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268057511","type":"CDM"},{"code":"50268057511","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NIACIN TAB ER 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268058311","type":"CDM"},{"code":"50268058311","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NIACIN TAB ER 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268058315","type":"CDM"},{"code":"50268058315","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059411","type":"CDM"},{"code":"50268059411","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059415","type":"CDM"},{"code":"50268059415","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059711","type":"CDM"},{"code":"50268059711","type":"NDC"}],"standard_charges":[{"gross_charge":11.37,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268059715","type":"CDM"},{"code":"50268059715","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268060411","type":"CDM"},{"code":"50268060411","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268060415","type":"CDM"},{"code":"50268060415","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268061511","type":"CDM"},{"code":"50268061511","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268061513","type":"CDM"},{"code":"50268061513","type":"NDC"}],"standard_charges":[{"gross_charge":13.3,"discounted_cash":9.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062511","type":"CDM"},{"code":"50268062511","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268062515","type":"CDM"},{"code":"50268062515","type":"NDC"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063011","type":"CDM"},{"code":"50268063011","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063015","type":"CDM"},{"code":"50268063015","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063211","type":"CDM"},{"code":"50268063211","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063911","type":"CDM"},{"code":"50268063911","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268063915","type":"CDM"},{"code":"50268063915","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068511","type":"CDM"},{"code":"50268068511","type":"NDC"}],"standard_charges":[{"gross_charge":11.78,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068515","type":"CDM"},{"code":"50268068515","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068611","type":"CDM"},{"code":"50268068611","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268068615","type":"CDM"},{"code":"50268068615","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RALOXIFENE HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268069415","type":"CDM"},{"code":"50268069415","type":"NDC"}],"standard_charges":[{"gross_charge":14.98,"discounted_cash":10.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268070111","type":"CDM"},{"code":"50268070111","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROSUVASTATIN CALCIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268071011","type":"CDM"},{"code":"50268071011","type":"NDC"}],"standard_charges":[{"gross_charge":11.46,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072411","type":"CDM"},{"code":"50268072411","type":"NDC"}],"standard_charges":[{"gross_charge":12.02,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072415","type":"CDM"},{"code":"50268072415","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SOTALOL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072511","type":"CDM"},{"code":"50268072511","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SOTALOL HCL TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268072515","type":"CDM"},{"code":"50268072515","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268073011","type":"CDM"},{"code":"50268073011","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268073015","type":"CDM"},{"code":"50268073015","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268074011","type":"CDM"},{"code":"50268074011","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268074015","type":"CDM"},{"code":"50268074015","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TORSEMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075511","type":"CDM"},{"code":"50268075511","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TORSEMIDE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075515","type":"CDM"},{"code":"50268075515","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075611","type":"CDM"},{"code":"50268075611","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268075615","type":"CDM"},{"code":"50268075615","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076411","type":"CDM"},{"code":"50268076411","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076415","type":"CDM"},{"code":"50268076415","type":"NDC"}],"standard_charges":[{"gross_charge":11.36,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076611","type":"CDM"},{"code":"50268076611","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268076615","type":"CDM"},{"code":"50268076615","type":"NDC"}],"standard_charges":[{"gross_charge":11.19,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268077911","type":"CDM"},{"code":"50268077911","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268077915","type":"CDM"},{"code":"50268077915","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":9.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268078815","type":"CDM"},{"code":"50268078815","type":"NDC"}],"standard_charges":[{"gross_charge":12.48,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268079911","type":"CDM"},{"code":"50268079911","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268079915","type":"CDM"},{"code":"50268079915","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268081815","type":"CDM"},{"code":"50268081815","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085111","type":"CDM"},{"code":"50268085111","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 1000 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085511","type":"CDM"},{"code":"50268085511","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 1000 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085515","type":"CDM"},{"code":"50268085515","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"B-COMPLEX W/BIOTIN & FOLIC ACID TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085711","type":"CDM"},{"code":"50268085711","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"B-COMPLEX W/BIOTIN & FOLIC ACID TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268085715","type":"CDM"},{"code":"50268085715","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASCORBIC ACID CHEW TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268086111","type":"CDM"},{"code":"50268086111","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASCORBIC ACID CHEW TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268086115","type":"CDM"},{"code":"50268086115","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 125 MCG (5000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268086611","type":"CDM"},{"code":"50268086611","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 125 MCG (5000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50268086615","type":"CDM"},{"code":"50268086615","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WITCH HAZEL-GLYCERIN CLEANSING PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50289325001","type":"CDM"},{"code":"50289325001","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL NASAL SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx50323000603","type":"CDM"},{"code":"50323000603","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISOLONE SOLN 15 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383004224","type":"CDM"},{"code":"J7510","type":"HCPCS"},{"code":"50383004224","type":"NDC"}],"standard_charges":[{"gross_charge":12.01,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE BITART-HOMATROPINE METHYLBROM SOLN 5-1.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383004316","type":"CDM"},{"code":"50383004316","type":"NDC"}],"standard_charges":[{"gross_charge":12.81,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx50383007916","type":"CDM"},{"code":"50383007916","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383008710","type":"CDM"},{"code":"50383008710","type":"NDC"}],"standard_charges":[{"gross_charge":12.02,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383008712","type":"CDM"},{"code":"50383008712","type":"NDC"}],"standard_charges":[{"gross_charge":12.33,"discounted_cash":8.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM ORAL SOLN 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383024116","type":"CDM"},{"code":"50383024116","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL VISCOUS SOLN 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383077515","type":"CDM"},{"code":"50383077515","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx50383077915","type":"CDM"},{"code":"50383077915","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx50383077917","type":"CDM"},{"code":"50383077917","type":"NDC"}],"standard_charges":[{"gross_charge":11.49,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR SUSP 200 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx50383081016","type":"CDM"},{"code":"50383081016","type":"NDC"}],"standard_charges":[{"gross_charge":16.58,"discounted_cash":11.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50383082416","type":"CDM"},{"code":"50383082416","type":"NDC"}],"standard_charges":[{"gross_charge":13.35,"discounted_cash":9.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50383093093","type":"CDM"},{"code":"J0571","type":"HCPCS"},{"code":"50383093093","type":"NDC"}],"standard_charges":[{"gross_charge":13.82,"discounted_cash":9.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CANAGLIFLOZIN TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458014030","type":"CDM"},{"code":"50458014030","type":"NDC"}],"standard_charges":[{"gross_charge":22.62,"discounted_cash":15.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CANAGLIFLOZIN TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458014090","type":"CDM"},{"code":"50458014090","type":"NDC"}],"standard_charges":[{"gross_charge":22.62,"discounted_cash":15.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIVAROXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057701","type":"CDM"},{"code":"50458057701","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":10.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIVAROXABAN TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057801","type":"CDM"},{"code":"50458057801","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIVAROXABAN TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057810","type":"CDM"},{"code":"50458057810","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIVAROXABAN TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458057830","type":"CDM"},{"code":"50458057830","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIVAROXABAN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458058001","type":"CDM"},{"code":"50458058001","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIVAROXABAN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458058010","type":"CDM"},{"code":"50458058010","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIVAROXABAN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50458058030","type":"CDM"},{"code":"50458058030","type":"NDC"}],"standard_charges":[{"gross_charge":10.13,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"COLLAGENASE OINT 250 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx50484001030","type":"CDM"},{"code":"50484001030","type":"NDC"}],"standard_charges":[{"gross_charge":796.2,"discounted_cash":557.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50532011310","type":"CDM"},{"code":"50532011310","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50580041202","type":"CDM"},{"code":"50580041202","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50580045711","type":"CDM"},{"code":"50580045711","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50580045811","type":"CDM"},{"code":"50580045811","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50580060002","type":"CDM"},{"code":"50580060002","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx50580060121","type":"CDM"},{"code":"50580060121","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RABIES VACCINE, PCEC FOR INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50632001001","type":"CDM"},{"code":"90675","type":"HCPCS"},{"code":"50632001001","type":"NDC"}],"standard_charges":[{"gross_charge":785.34,"discounted_cash":549.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIGOXIN IMMUNE FAB FOR INJ 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50633012011","type":"CDM"},{"code":"J1162","type":"HCPCS"},{"code":"50633012011","type":"NDC"}],"standard_charges":[{"gross_charge":18607.49,"discounted_cash":13025.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXOCOBALAMIN (ANTIDOTE) FOR IV SOLN 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50633031011","type":"CDM"},{"code":"50633031011","type":"NDC"}],"standard_charges":[{"gross_charge":3732.26,"discounted_cash":2612.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 5 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742037201","type":"CDM"},{"code":"50742037201","type":"NDC"}],"standard_charges":[{"gross_charge":83.92,"discounted_cash":58.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE TD PATCH WEEKLY 5 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742037204","type":"CDM"},{"code":"50742037204","type":"NDC"}],"standard_charges":[{"gross_charge":83.92,"discounted_cash":58.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742050501","type":"CDM"},{"code":"50742050501","type":"NDC"}],"standard_charges":[{"gross_charge":28.11,"discounted_cash":19.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742050504","type":"CDM"},{"code":"50742050504","type":"NDC"}],"standard_charges":[{"gross_charge":22.19,"discounted_cash":15.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742050510","type":"CDM"},{"code":"50742050510","type":"NDC"}],"standard_charges":[{"gross_charge":22.34,"discounted_cash":15.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742054901","type":"CDM"},{"code":"50742054901","type":"NDC"}],"standard_charges":[{"gross_charge":30.39,"discounted_cash":21.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx50742061601","type":"CDM"},{"code":"50742061601","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ARTIFICIAL SALIVA - SOLUTION","drug_information":{"unit":59.0,"type":"ML"},"code_information":[{"code":"Rx50930009802","type":"CDM"},{"code":"50930009802","type":"NDC"}],"standard_charges":[{"gross_charge":6.07,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOLAZONE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002301","type":"CDM"},{"code":"51079002301","type":"NDC"}],"standard_charges":[{"gross_charge":14.2,"discounted_cash":9.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOLAZONE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079002320","type":"CDM"},{"code":"51079002320","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079005101","type":"CDM"},{"code":"51079005101","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079005120","type":"CDM"},{"code":"51079005120","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007201","type":"CDM"},{"code":"51079007201","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007220","type":"CDM"},{"code":"51079007220","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007301","type":"CDM"},{"code":"51079007301","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007320","type":"CDM"},{"code":"51079007320","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007501","type":"CDM"},{"code":"51079007501","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007520","type":"CDM"},{"code":"51079007520","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007701","type":"CDM"},{"code":"51079007701","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079007720","type":"CDM"},{"code":"51079007720","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079008601","type":"CDM"},{"code":"51079008601","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIRTAZAPINE TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079008620","type":"CDM"},{"code":"51079008620","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010301","type":"CDM"},{"code":"51079010301","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010320","type":"CDM"},{"code":"51079010320","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010501","type":"CDM"},{"code":"51079010501","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010520","type":"CDM"},{"code":"51079010520","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010701","type":"CDM"},{"code":"51079010701","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079010720","type":"CDM"},{"code":"51079010720","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079011801","type":"CDM"},{"code":"51079011801","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079011820","type":"CDM"},{"code":"51079011820","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079012901","type":"CDM"},{"code":"51079012901","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079012906","type":"CDM"},{"code":"51079012906","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079013101","type":"CDM"},{"code":"51079013101","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079013120","type":"CDM"},{"code":"51079013120","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014101","type":"CDM"},{"code":"51079014101","type":"NDC"}],"standard_charges":[{"gross_charge":12.38,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079014120","type":"CDM"},{"code":"51079014120","type":"NDC"}],"standard_charges":[{"gross_charge":12.44,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016901","type":"CDM"},{"code":"51079016901","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079016920","type":"CDM"},{"code":"51079016920","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079017001","type":"CDM"},{"code":"51079017001","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079017020","type":"CDM"},{"code":"51079017020","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079018201","type":"CDM"},{"code":"51079018201","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079018220","type":"CDM"},{"code":"51079018220","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019701","type":"CDM"},{"code":"51079019701","type":"NDC"}],"standard_charges":[{"gross_charge":26.92,"discounted_cash":18.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOLTERODINE TARTRATE CAP ER 24HR 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019703","type":"CDM"},{"code":"51079019703","type":"NDC"}],"standard_charges":[{"gross_charge":26.92,"discounted_cash":18.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019901","type":"CDM"},{"code":"51079019901","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079019920","type":"CDM"},{"code":"51079019920","type":"NDC"}],"standard_charges":[{"gross_charge":14.17,"discounted_cash":9.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020501","type":"CDM"},{"code":"51079020501","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020520","type":"CDM"},{"code":"51079020520","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020801","type":"CDM"},{"code":"51079020801","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079020820","type":"CDM"},{"code":"51079020820","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079021001","type":"CDM"},{"code":"51079021001","type":"NDC"}],"standard_charges":[{"gross_charge":10.97,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079021020","type":"CDM"},{"code":"51079021020","type":"NDC"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079024601","type":"CDM"},{"code":"51079024601","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079024620","type":"CDM"},{"code":"51079024620","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079025501","type":"CDM"},{"code":"51079025501","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079025520","type":"CDM"},{"code":"51079025520","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028401","type":"CDM"},{"code":"51079028401","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028420","type":"CDM"},{"code":"51079028420","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028501","type":"CDM"},{"code":"51079028501","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079028520","type":"CDM"},{"code":"51079028520","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079029401","type":"CDM"},{"code":"51079029401","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079030601","type":"CDM"},{"code":"51079030601","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079030630","type":"CDM"},{"code":"51079030630","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079034820","type":"CDM"},{"code":"51079034820","type":"NDC"}],"standard_charges":[{"gross_charge":15.71,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038501","type":"CDM"},{"code":"51079038501","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBAMAZEPINE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038520","type":"CDM"},{"code":"51079038520","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038601","type":"CDM"},{"code":"51079038601","type":"NDC"}],"standard_charges":[{"gross_charge":13.23,"discounted_cash":9.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079038620","type":"CDM"},{"code":"51079038620","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041701","type":"CDM"},{"code":"51079041701","type":"NDC"}],"standard_charges":[{"gross_charge":12.84,"discounted_cash":8.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041720","type":"CDM"},{"code":"51079041720","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":8.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041801","type":"CDM"},{"code":"51079041801","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079041820","type":"CDM"},{"code":"51079041820","type":"NDC"}],"standard_charges":[{"gross_charge":11.69,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079042501","type":"CDM"},{"code":"51079042501","type":"NDC"}],"standard_charges":[{"gross_charge":11.33,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079042520","type":"CDM"},{"code":"51079042520","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXEPIN HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043601","type":"CDM"},{"code":"51079043601","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXEPIN HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043620","type":"CDM"},{"code":"51079043620","type":"NDC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043701","type":"CDM"},{"code":"51079043701","type":"NDC"}],"standard_charges":[{"gross_charge":11.27,"discounted_cash":7.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXEPIN HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079043720","type":"CDM"},{"code":"51079043720","type":"NDC"}],"standard_charges":[{"gross_charge":11.42,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044001","type":"CDM"},{"code":"51079044001","type":"NDC"}],"standard_charges":[{"gross_charge":10.87,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044020","type":"CDM"},{"code":"51079044020","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044201","type":"CDM"},{"code":"51079044201","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044220","type":"CDM"},{"code":"51079044220","type":"NDC"}],"standard_charges":[{"gross_charge":11.19,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044401","type":"CDM"},{"code":"51079044401","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044420","type":"CDM"},{"code":"51079044420","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044501","type":"CDM"},{"code":"51079044501","type":"NDC"}],"standard_charges":[{"gross_charge":11.24,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 150 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079044520","type":"CDM"},{"code":"51079044520","type":"NDC"}],"standard_charges":[{"gross_charge":11.42,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045101","type":"CDM"},{"code":"51079045101","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045120","type":"CDM"},{"code":"51079045120","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045801","type":"CDM"},{"code":"51079045801","type":"NDC"}],"standard_charges":[{"gross_charge":11.19,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079045820","type":"CDM"},{"code":"51079045820","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048001","type":"CDM"},{"code":"51079048001","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079048020","type":"CDM"},{"code":"51079048020","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079049801","type":"CDM"},{"code":"51079049801","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079049820","type":"CDM"},{"code":"51079049820","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079049901","type":"CDM"},{"code":"51079049901","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079049920","type":"CDM"},{"code":"51079049920","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079052701","type":"CDM"},{"code":"51079052701","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079052720","type":"CDM"},{"code":"51079052720","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079054320","type":"CDM"},{"code":"51079054320","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079055801","type":"CDM"},{"code":"51079055801","type":"NDC"}],"standard_charges":[{"gross_charge":47.01,"discounted_cash":32.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079055803","type":"CDM"},{"code":"51079055803","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":20.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CETIRIZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079059701","type":"CDM"},{"code":"51079059701","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079062001","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"51079062001","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079062006","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"51079062006","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079064401","type":"CDM"},{"code":"51079064401","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079064420","type":"CDM"},{"code":"51079064420","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079067001","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"51079067001","type":"NDC"}],"standard_charges":[{"gross_charge":14.2,"discounted_cash":9.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079067005","type":"CDM"},{"code":"J8610","type":"HCPCS"},{"code":"51079067005","type":"NDC"}],"standard_charges":[{"gross_charge":14.67,"discounted_cash":10.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATENOLOL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079068401","type":"CDM"},{"code":"51079068401","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATENOLOL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079068420","type":"CDM"},{"code":"51079068420","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079069001","type":"CDM"},{"code":"51079069001","type":"NDC"}],"standard_charges":[{"gross_charge":11.31,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079069020","type":"CDM"},{"code":"51079069020","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072101","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"51079072101","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MYCOPHENOLATE MOFETIL CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072120","type":"CDM"},{"code":"J7517","type":"HCPCS"},{"code":"51079072120","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072401","type":"CDM"},{"code":"51079072401","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLPIDEM TARTRATE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079072420","type":"CDM"},{"code":"51079072420","type":"NDC"}],"standard_charges":[{"gross_charge":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073301","type":"CDM"},{"code":"51079073301","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073320","type":"CDM"},{"code":"51079073320","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073501","type":"CDM"},{"code":"51079073501","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079073520","type":"CDM"},{"code":"51079073520","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074601","type":"CDM"},{"code":"51079074601","type":"NDC"}],"standard_charges":[{"gross_charge":11.42,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079074620","type":"CDM"},{"code":"51079074620","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079075301","type":"CDM"},{"code":"51079075301","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079075320","type":"CDM"},{"code":"51079075320","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079075901","type":"CDM"},{"code":"51079075901","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATENOLOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079075920","type":"CDM"},{"code":"51079075920","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077401","type":"CDM"},{"code":"51079077401","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077420","type":"CDM"},{"code":"51079077420","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE CAP 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077601","type":"CDM"},{"code":"51079077601","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE CAP 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077620","type":"CDM"},{"code":"51079077620","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079077720","type":"CDM"},{"code":"51079077720","type":"NDC"}],"standard_charges":[{"gross_charge":11.96,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079078901","type":"CDM"},{"code":"51079078901","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079078920","type":"CDM"},{"code":"51079078920","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079079301","type":"CDM"},{"code":"51079079301","type":"NDC"}],"standard_charges":[{"gross_charge":11.61,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079079320","type":"CDM"},{"code":"51079079320","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079079601","type":"CDM"},{"code":"51079079601","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079079620","type":"CDM"},{"code":"51079079620","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080101","type":"CDM"},{"code":"51079080101","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080120","type":"CDM"},{"code":"51079080120","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079080601","type":"CDM"},{"code":"51079080601","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLIPIZIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081001","type":"CDM"},{"code":"51079081001","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLIPIZIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081020","type":"CDM"},{"code":"51079081020","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081201","type":"CDM"},{"code":"51079081201","type":"NDC"}],"standard_charges":[{"gross_charge":15.92,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NADOLOL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079081220","type":"CDM"},{"code":"51079081220","type":"NDC"}],"standard_charges":[{"gross_charge":19.03,"discounted_cash":13.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079082101","type":"CDM"},{"code":"51079082101","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079082120","type":"CDM"},{"code":"51079082120","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086301","type":"CDM"},{"code":"51079086301","type":"NDC"}],"standard_charges":[{"gross_charge":12.38,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086320","type":"CDM"},{"code":"51079086320","type":"NDC"}],"standard_charges":[{"gross_charge":12.37,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INDAPAMIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086801","type":"CDM"},{"code":"51079086801","type":"NDC"}],"standard_charges":[{"gross_charge":11.7,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INDAPAMIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079086820","type":"CDM"},{"code":"51079086820","type":"NDC"}],"standard_charges":[{"gross_charge":11.13,"discounted_cash":7.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088601","type":"CDM"},{"code":"51079088601","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088620","type":"CDM"},{"code":"51079088620","type":"NDC"}],"standard_charges":[{"gross_charge":11.43,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088801","type":"CDM"},{"code":"51079088801","type":"NDC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079088820","type":"CDM"},{"code":"51079088820","type":"NDC"}],"standard_charges":[{"gross_charge":11.37,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089401","type":"CDM"},{"code":"51079089401","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089420","type":"CDM"},{"code":"51079089420","type":"NDC"}],"standard_charges":[{"gross_charge":13.31,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089901","type":"CDM"},{"code":"51079089901","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079089920","type":"CDM"},{"code":"51079089920","type":"NDC"}],"standard_charges":[{"gross_charge":13.55,"discounted_cash":9.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079090501","type":"CDM"},{"code":"51079090501","type":"NDC"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079090520","type":"CDM"},{"code":"51079090520","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093001","type":"CDM"},{"code":"51079093001","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARVEDILOL TAB 6.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093020","type":"CDM"},{"code":"51079093020","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093201","type":"CDM"},{"code":"51079093201","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARVEDILOL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093220","type":"CDM"},{"code":"51079093220","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093501","type":"CDM"},{"code":"51079093501","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE CAP 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093520","type":"CDM"},{"code":"51079093520","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093601","type":"CDM"},{"code":"51079093601","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093620","type":"CDM"},{"code":"51079093620","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093801","type":"CDM"},{"code":"51079093801","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079093820","type":"CDM"},{"code":"51079093820","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079094301","type":"CDM"},{"code":"51079094301","type":"NDC"}],"standard_charges":[{"gross_charge":11.48,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079094320","type":"CDM"},{"code":"51079094320","type":"NDC"}],"standard_charges":[{"gross_charge":11.88,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079095801","type":"CDM"},{"code":"51079095801","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079095820","type":"CDM"},{"code":"51079095820","type":"NDC"}],"standard_charges":[{"gross_charge":15.26,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079096601","type":"CDM"},{"code":"51079096601","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079096620","type":"CDM"},{"code":"51079096620","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079097801","type":"CDM"},{"code":"51079097801","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079097820","type":"CDM"},{"code":"51079097820","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098201","type":"CDM"},{"code":"51079098201","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098220","type":"CDM"},{"code":"51079098220","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098501","type":"CDM"},{"code":"51079098501","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098520","type":"CDM"},{"code":"51079098520","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098601","type":"CDM"},{"code":"51079098601","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUSPIRONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079098620","type":"CDM"},{"code":"51079098620","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099101","type":"CDM"},{"code":"51079099101","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099120","type":"CDM"},{"code":"51079099120","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099801","type":"CDM"},{"code":"51079099801","type":"NDC"}],"standard_charges":[{"gross_charge":12.85,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51079099820","type":"CDM"},{"code":"51079099820","type":"NDC"}],"standard_charges":[{"gross_charge":11.13,"discounted_cash":7.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51224001210","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"51224001210","type":"NDC"}],"standard_charges":[{"gross_charge":1583.36,"discounted_cash":1108.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51224001220","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"51224001220","type":"NDC"}],"standard_charges":[{"gross_charge":1193.6,"discounted_cash":835.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51224001301","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"51224001301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51224001310","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"51224001310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51224002230","type":"CDM"},{"code":"51224002230","type":"NDC"}],"standard_charges":[{"gross_charge":13.73,"discounted_cash":9.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51293080101","type":"CDM"},{"code":"51293080101","type":"NDC"}],"standard_charges":[{"gross_charge":13.1,"discounted_cash":9.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51293081001","type":"CDM"},{"code":"51293081001","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZOCAINE-MENTHOL AEROSOL 20-0.5%","drug_information":{"unit":78.0,"type":"GM"},"code_information":[{"code":"Rx51409000722","type":"CDM"},{"code":"51409000722","type":"NDC"}],"standard_charges":[{"gross_charge":4.29,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51645090599","type":"CDM"},{"code":"51645090599","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOBETASOL PROPIONATE CREAM 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672125801","type":"CDM"},{"code":"51672125801","type":"NDC"}],"standard_charges":[{"gross_charge":76.88,"discounted_cash":53.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672125901","type":"CDM"},{"code":"51672125901","type":"NDC"}],"standard_charges":[{"gross_charge":63.66,"discounted_cash":44.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE CREAM 100000-0.1 UNIT/GM-%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672126301","type":"CDM"},{"code":"51672126301","type":"NDC"}],"standard_charges":[{"gross_charge":106.6,"discounted_cash":74.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN-TRIAMCINOLONE CREAM 100000-0.1 UNIT/GM-%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx51672126302","type":"CDM"},{"code":"51672126302","type":"NDC"}],"standard_charges":[{"gross_charge":129.28,"discounted_cash":90.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672128201","type":"CDM"},{"code":"51672128201","type":"NDC"}],"standard_charges":[{"gross_charge":61.5,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN CREAM 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672128901","type":"CDM"},{"code":"51672128901","type":"NDC"}],"standard_charges":[{"gross_charge":73.86,"discounted_cash":51.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":22.0,"type":"GM"},"code_information":[{"code":"Rx51672131200","type":"CDM"},{"code":"51672131200","type":"NDC"}],"standard_charges":[{"gross_charge":63.6,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51672131201","type":"CDM"},{"code":"51672131201","type":"NDC"}],"standard_charges":[{"gross_charge":59.13,"discounted_cash":41.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx51672201302","type":"CDM"},{"code":"51672201302","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICONAZOLE NITRATE VAGINAL CREAM 2%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx51672203506","type":"CDM"},{"code":"51672203506","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx51672206902","type":"CDM"},{"code":"51672206902","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx51672207502","type":"CDM"},{"code":"51672207502","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672211500","type":"CDM"},{"code":"51672211500","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672211502","type":"CDM"},{"code":"51672211502","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672211600","type":"CDM"},{"code":"51672211600","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUPPOS 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672211602","type":"CDM"},{"code":"51672211602","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672400205","type":"CDM"},{"code":"51672400205","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAZOLAMIDE TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672402301","type":"CDM"},{"code":"51672402301","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL ORAL SOLN 4 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx51672409103","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"51672409103","type":"NDC"}],"standard_charges":[{"gross_charge":13.09,"discounted_cash":9.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672411101","type":"CDM"},{"code":"51672411101","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672412401","type":"CDM"},{"code":"51672412401","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51672414601","type":"CDM"},{"code":"51672414601","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx51754500101","type":"CDM"},{"code":"51754500101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx51754506001","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"51754506001","type":"NDC"}],"standard_charges":[{"gross_charge":108.69,"discounted_cash":76.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID EFFER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801001101","type":"CDM"},{"code":"51801001101","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID EFFER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801001130","type":"CDM"},{"code":"51801001130","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID EFFER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801001201","type":"CDM"},{"code":"51801001201","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID EFFER TAB 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51801001230","type":"CDM"},{"code":"51801001230","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRAMOXINE HCL PERIANAL FOAM 1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx51862018015","type":"CDM"},{"code":"51862018015","type":"NDC"}],"standard_charges":[{"gross_charge":37.57,"discounted_cash":26.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIMETHOPRIM TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51862048601","type":"CDM"},{"code":"51862048601","type":"NDC"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLERGONOVINE MALEATE INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx51991014499","type":"CDM"},{"code":"J2210","type":"HCPCS"},{"code":"51991014499","type":"NDC"}],"standard_charges":[{"gross_charge":187.77,"discounted_cash":131.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx51991029201","type":"CDM"},{"code":"51991029201","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx51991093498","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"51991093498","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx51991098317","type":"CDM"},{"code":"51991098317","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx51991098399","type":"CDM"},{"code":"51991098399","type":"NDC"}],"standard_charges":[{"gross_charge":119.18,"discounted_cash":83.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FIDAXOMICIN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52015008001","type":"CDM"},{"code":"52015008001","type":"NDC"}],"standard_charges":[{"gross_charge":228.77,"discounted_cash":160.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THEOPHYLLINE CAP ER 24HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52244020010","type":"CDM"},{"code":"52244020010","type":"NDC"}],"standard_charges":[{"gross_charge":19.97,"discounted_cash":13.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PEG 3350-KCL-NA BICARB-NACL-NA SULFATE FOR SOLN 236 GM","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"Rx52268010001","type":"CDM"},{"code":"52268010001","type":"NDC"}],"standard_charges":[{"gross_charge":47.52,"discounted_cash":33.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PEG 3350-KCL-SOD BICARB-NACL FOR SOLN 420 GM","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"Rx52268040001","type":"CDM"},{"code":"52268040001","type":"NDC"}],"standard_charges":[{"gross_charge":32.56,"discounted_cash":22.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORHEXIDINE GLUCONATE SOLN 4%","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"Rx52380127204","type":"CDM"},{"code":"52380127204","type":"NDC"}],"standard_charges":[{"gross_charge":6.72,"discounted_cash":4.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL SOLN 4%,LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx52565000950","type":"CDM"},{"code":"52565000950","type":"NDC"}],"standard_charges":[{"gross_charge":193.77,"discounted_cash":135.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYPROHEPTADINE HCL TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817021010","type":"CDM"},{"code":"52817021010","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx52817039010","type":"CDM"},{"code":"52817039010","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICONAZOLE NITRATE POWDER 2%","drug_information":{"unit":85.0,"type":"GM"},"code_information":[{"code":"Rx53329016979","type":"CDM"},{"code":"53329016979","type":"NDC"}],"standard_charges":[{"gross_charge":4.93,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PATIROMER SORBITEX CALCIUM FOR SUSP PACKET 8.4 GM (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53436008401","type":"CDM"},{"code":"53436008401","type":"NDC"}],"standard_charges":[{"gross_charge":82.87,"discounted_cash":58.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PATIROMER SORBITEX CALCIUM FOR SUSP PACKET 8.4 GM (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53436008404","type":"CDM"},{"code":"53436008404","type":"NDC"}],"standard_charges":[{"gross_charge":88.99,"discounted_cash":62.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAPROXEN SODIUM TAB 275 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746019301","type":"CDM"},{"code":"53746019301","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx53746054401","type":"CDM"},{"code":"53746054401","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MESALAMINE CAP ER 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54092018981","type":"CDM"},{"code":"54092018981","type":"NDC"}],"standard_charges":[{"gross_charge":15.32,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MESALAMINE CAP ER 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54092019112","type":"CDM"},{"code":"54092019112","type":"NDC"}],"standard_charges":[{"gross_charge":20.52,"discounted_cash":14.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VITAMINS A & D OINT","drug_information":{"unit":56.0,"type":"GM"},"code_information":[{"code":"Rx54162000002","type":"CDM"},{"code":"54162000002","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MENTHOL-METHYL SALICYLATE OINTMENT","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx54162055501","type":"CDM"},{"code":"54162055501","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SORBITOL ORAL SOLUTION 70%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx54162070016","type":"CDM"},{"code":"54162070016","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx54288010301","type":"CDM"},{"code":"54288010301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx54288010310","type":"CDM"},{"code":"54288010310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx54288012001","type":"CDM"},{"code":"54288012001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54288012501","type":"CDM"},{"code":"54288012501","type":"NDC"}],"standard_charges":[{"gross_charge":18.78,"discounted_cash":13.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54288012530","type":"CDM"},{"code":"54288012530","type":"NDC"}],"standard_charges":[{"gross_charge":18.69,"discounted_cash":13.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLENE BLUE IV SOLN 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx54288014701","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"54288014701","type":"NDC"}],"standard_charges":[{"gross_charge":1093.04,"discounted_cash":765.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FERROUS GLUCONATE TAB 324 MG (37.5 MG ELEMENTAL IRON)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54629064501","type":"CDM"},{"code":"54629064501","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 125 MCG (5000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx54629794101","type":"CDM"},{"code":"54629794101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN LIQUID 160 MG/5ML","drug_information":{"unit":10.15625,"type":"ML"},"code_information":[{"code":"Rx54838014440","type":"CDM"},{"code":"54838014440","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL LACTATE ORAL CONC 2 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx54838050140","type":"CDM"},{"code":"54838050140","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx54879000716","type":"CDM"},{"code":"54879000716","type":"NDC"}],"standard_charges":[{"gross_charge":13.59,"discounted_cash":9.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111012601","type":"CDM"},{"code":"55111012601","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZIPRASIDONE HCL CAP 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111025660","type":"CDM"},{"code":"55111025660","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111026279","type":"CDM"},{"code":"55111026279","type":"NDC"}],"standard_charges":[{"gross_charge":18.77,"discounted_cash":13.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOFLOXACIN TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111028050","type":"CDM"},{"code":"55111028050","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111029209","type":"CDM"},{"code":"55111029209","type":"NDC"}],"standard_charges":[{"gross_charge":13.19,"discounted_cash":9.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55111067131","type":"CDM"},{"code":"55111067131","type":"NDC"}],"standard_charges":[{"gross_charge":39.98,"discounted_cash":27.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55111067802","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111067802","type":"NDC"}],"standard_charges":[{"gross_charge":115.91,"discounted_cash":81.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55111067811","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111067811","type":"NDC"}],"standard_charges":[{"gross_charge":150.73,"discounted_cash":105.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55111068002","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111068002","type":"NDC"}],"standard_charges":[{"gross_charge":863.53,"discounted_cash":604.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55111068010","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111068010","type":"NDC"}],"standard_charges":[{"gross_charge":456.56,"discounted_cash":319.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55111068011","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111068011","type":"NDC"}],"standard_charges":[{"gross_charge":371.65,"discounted_cash":260.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx55111068102","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111068102","type":"NDC"}],"standard_charges":[{"gross_charge":595.77,"discounted_cash":417.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx55111068111","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55111068111","type":"NDC"}],"standard_charges":[{"gross_charge":464.59,"discounted_cash":325.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55111068852","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"55111068852","type":"NDC"}],"standard_charges":[{"gross_charge":668.11,"discounted_cash":467.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011310","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"55150011310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011620","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150011720","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"55150011720","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012030","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012150","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150012315","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"55150012315","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150012502","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"55150012502","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150015410","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"55150015410","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150015411","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"55150015411","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx55150015520","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"55150015520","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx55150015521","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"55150015521","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150015974","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150015974","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016102","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150016102","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016205","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"55150016205","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150016505","type":"CDM"},{"code":"55150016505","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150016710","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150016710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150016830","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150016830","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150016910","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150016910","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150017030","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150017030","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.75%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150017230","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"55150017230","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150017301","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"55150017301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150017410","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"55150017410","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150017705","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"55150017705","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx55150018003","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"55150018003","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150018301","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"55150018301","type":"NDC"}],"standard_charges":[{"gross_charge":211.31,"discounted_cash":147.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICARDIPINE HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150018310","type":"CDM"},{"code":"J2404","type":"HCPCS"},{"code":"55150018310","type":"NDC"}],"standard_charges":[{"gross_charge":169.65,"discounted_cash":118.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx55150019410","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"55150019410","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020200","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"55150020200","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020720","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150020830","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"55150020830","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETOMIDATE IV SOLN 2 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx55150022110","type":"CDM"},{"code":"55150022110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55150023200","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55150023200","type":"NDC"}],"standard_charges":[{"gross_charge":410.86,"discounted_cash":287.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 7.5 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55150023210","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55150023210","type":"NDC"}],"standard_charges":[{"gross_charge":120.51,"discounted_cash":84.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx55150023300","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"55150023300","type":"NDC"}],"standard_charges":[{"gross_charge":433.06,"discounted_cash":303.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150023501","type":"CDM"},{"code":"55150023501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150023510","type":"CDM"},{"code":"55150023510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx55150024251","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"55150024251","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150025110","type":"CDM"},{"code":"55150025110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx55150025930","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"55150025930","type":"NDC"}],"standard_charges":[{"gross_charge":459.35,"discounted_cash":321.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150028220","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"55150028220","type":"NDC"}],"standard_charges":[{"gross_charge":375.12,"discounted_cash":262.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55150029701","type":"CDM"},{"code":"55150029701","type":"NDC"}],"standard_charges":[{"gross_charge":510.73,"discounted_cash":357.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx55150029710","type":"CDM"},{"code":"55150029710","type":"NDC"}],"standard_charges":[{"gross_charge":219.1,"discounted_cash":153.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx55150030401","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"55150030401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PRESERVATIVE FREE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx55150030425","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"55150030425","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE FOR IM INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150030801","type":"CDM"},{"code":"J2359","type":"HCPCS"},{"code":"55150030801","type":"NDC"}],"standard_charges":[{"gross_charge":203.52,"discounted_cash":142.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150032301","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"55150032301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150032325","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"55150032325","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150032901","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"55150032901","type":"NDC"}],"standard_charges":[{"gross_charge":349.64,"discounted_cash":244.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55150032925","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"55150032925","type":"NDC"}],"standard_charges":[{"gross_charge":349.67,"discounted_cash":244.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150034401","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"55150034401","type":"NDC"}],"standard_charges":[{"gross_charge":183.16,"discounted_cash":128.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx55150034501","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"55150034501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx55150034510","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"55150034510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150042501","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150042501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx55150042510","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150042510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETAMINE HCL INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150043801","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150043801","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETAMINE HCL INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx55150043810","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"55150043810","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150047101","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"55150047101","type":"NDC"}],"standard_charges":[{"gross_charge":257.89,"discounted_cash":180.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55150047110","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"55150047110","type":"NDC"}],"standard_charges":[{"gross_charge":147.31,"discounted_cash":103.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55154358204","type":"CDM"},{"code":"55154358204","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPOETIN ALFA INJ 2000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513012601","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"55513012601","type":"NDC"}],"standard_charges":[{"gross_charge":483.8,"discounted_cash":338.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPOETIN ALFA INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513014401","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"55513014401","type":"NDC"}],"standard_charges":[{"gross_charge":1967.2,"discounted_cash":1377.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PEGFILGRASTIM SOLN PREFILLED SYRINGE 6 MG/0.6ML","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"Rx55513019001","type":"CDM"},{"code":"J2506","type":"HCPCS"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"gross_charge":15612.97,"discounted_cash":10929.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML (600 MCG/ML)","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx55513020901","type":"CDM"},{"code":"J1442","type":"HCPCS"},{"code":"55513020901","type":"NDC"}],"standard_charges":[{"gross_charge":2007.71,"discounted_cash":1405.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML (600 MCG/ML)","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx55513020910","type":"CDM"},{"code":"J1442","type":"HCPCS"},{"code":"55513020910","type":"NDC"}],"standard_charges":[{"gross_charge":1985.4,"discounted_cash":1389.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROMIPLOSTIM FOR INJ 250 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513022101","type":"CDM"},{"code":"J2802","type":"HCPCS"},{"code":"55513022101","type":"NDC"}],"standard_charges":[{"gross_charge":11175.03,"discounted_cash":7822.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROMIPLOSTIM FOR INJ 125 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx55513022301","type":"CDM"},{"code":"J2802","type":"HCPCS"},{"code":"55513022301","type":"NDC"}],"standard_charges":[{"gross_charge":5587.6,"discounted_cash":3911.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM INJ 300 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513053001","type":"CDM"},{"code":"J1442","type":"HCPCS"},{"code":"55513053001","type":"NDC"}],"standard_charges":[{"gross_charge":1189.43,"discounted_cash":832.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM INJ 300 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513053010","type":"CDM"},{"code":"J1442","type":"HCPCS"},{"code":"55513053010","type":"NDC"}],"standard_charges":[{"gross_charge":1176.21,"discounted_cash":823.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM INJ 480 MCG/1.6ML (300 MCG/ML)","drug_information":{"unit":1.6,"type":"ML"},"code_information":[{"code":"Rx55513054601","type":"CDM"},{"code":"J1442","type":"HCPCS"},{"code":"55513054601","type":"NDC"}],"standard_charges":[{"gross_charge":1894.0,"discounted_cash":1325.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM INJ 480 MCG/1.6ML (300 MCG/ML)","drug_information":{"unit":1.6,"type":"ML"},"code_information":[{"code":"Rx55513054610","type":"CDM"},{"code":"J1442","type":"HCPCS"},{"code":"55513054610","type":"NDC"}],"standard_charges":[{"gross_charge":1872.96,"discounted_cash":1311.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DENOSUMAB INJ SOLN PREFILLED SYRINGE 60 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513071001","type":"CDM"},{"code":"J0897","type":"HCPCS"},{"code":"55513071001","type":"NDC"}],"standard_charges":[{"gross_charge":7013.6,"discounted_cash":4909.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DENOSUMAB INJ SOLN PREFILLED SYRINGE 60 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx55513071021","type":"CDM"},{"code":"J0897","type":"HCPCS"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"gross_charge":7015.88,"discounted_cash":4911.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROMOSOZUMAB-AQQG INJ SOLN PREFILLED SYRINGE 105 MG/1.17ML","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"Rx55513088001","type":"CDM"},{"code":"J3111","type":"HCPCS"},{"code":"55513088001","type":"NDC"}],"standard_charges":[{"gross_charge":10671.32,"discounted_cash":7469.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROMOSOZUMAB-AQQG INJ SOLN PREFILLED SYRINGE 105 MG/1.17ML","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"Rx55513088002","type":"CDM"},{"code":"J3111","type":"HCPCS"},{"code":"55513088002","type":"NDC"}],"standard_charges":[{"gross_charge":10671.32,"discounted_cash":7469.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROMOSOZUMAB-AQQG INJ SOLN PREFILLED SYRINGE 105 MG/1.17ML","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"Rx55513099801","type":"CDM"},{"code":"J3111","type":"HCPCS"},{"code":"55513099801","type":"NDC"}],"standard_charges":[{"gross_charge":10671.32,"discounted_cash":7469.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROMOSOZUMAB-AQQG INJ SOLN PREFILLED SYRINGE 105 MG/1.17ML","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"Rx55513099802","type":"CDM"},{"code":"J3111","type":"HCPCS"},{"code":"55513099802","type":"NDC"}],"standard_charges":[{"gross_charge":10671.32,"discounted_cash":7469.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SIMETHICONE SUSP 40 MG/0.6ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx56184012041","type":"CDM"},{"code":"56184012041","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237001830","type":"CDM"},{"code":"57237001830","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237007710","type":"CDM"},{"code":"57237007710","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237017301","type":"CDM"},{"code":"57237017301","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 50 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237017401","type":"CDM"},{"code":"57237017401","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237018190","type":"CDM"},{"code":"57237018190","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237022030","type":"CDM"},{"code":"57237022030","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237022090","type":"CDM"},{"code":"57237022090","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx57237031403","type":"CDM"},{"code":"57237031403","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx57237031431","type":"CDM"},{"code":"57237031431","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57237032201","type":"CDM"},{"code":"57237032201","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664012688","type":"CDM"},{"code":"57664012688","type":"NDC"}],"standard_charges":[{"gross_charge":11.8,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664022388","type":"CDM"},{"code":"57664022388","type":"NDC"}],"standard_charges":[{"gross_charge":11.79,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57664022888","type":"CDM"},{"code":"57664022888","type":"NDC"}],"standard_charges":[{"gross_charge":11.89,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx57664068331","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"57664068331","type":"NDC"}],"standard_charges":[{"gross_charge":305.51,"discounted_cash":213.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx57664068357","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"57664068357","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INFLIXIMAB FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57894003001","type":"CDM"},{"code":"J1745","type":"HCPCS"},{"code":"57894003001","type":"NDC"}],"standard_charges":[{"gross_charge":4366.57,"discounted_cash":3056.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"USTEKINUMAB IV SOLN 130 MG/26ML (5 MG/ML) (FOR IV INFUSION)","drug_information":{"unit":26.0,"type":"ML"},"code_information":[{"code":"Rx57894005427","type":"CDM"},{"code":"J3358","type":"HCPCS"},{"code":"57894005427","type":"NDC"}],"standard_charges":[{"gross_charge":8604.99,"discounted_cash":6023.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"USTEKINUMAB SOLN PREFILLED SYRINGE 90 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx57894006103","type":"CDM"},{"code":"J3357","type":"HCPCS"},{"code":"57894006103","type":"NDC"}],"standard_charges":[{"gross_charge":109018.53,"discounted_cash":76312.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GOLIMUMAB IV SOLN 50 MG/4ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx57894035001","type":"CDM"},{"code":"J1602","type":"HCPCS"},{"code":"57894035001","type":"NDC"}],"standard_charges":[{"gross_charge":7472.68,"discounted_cash":5230.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896040101","type":"CDM"},{"code":"57896040101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896053101","type":"CDM"},{"code":"57896053101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896062101","type":"CDM"},{"code":"57896062101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx57896062912","type":"CDM"},{"code":"57896062912","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES POWDER PACK 280-160-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896084401","type":"CDM"},{"code":"57896084401","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896087601","type":"CDM"},{"code":"57896087601","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896090101","type":"CDM"},{"code":"57896090101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896092101","type":"CDM"},{"code":"57896092101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57896094101","type":"CDM"},{"code":"57896094101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DALBAVANCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx57970010001","type":"CDM"},{"code":"J0875","type":"HCPCS"},{"code":"57970010001","type":"NDC"}],"standard_charges":[{"gross_charge":3739.72,"discounted_cash":2617.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPH, ACELLULAR PERT & TET TOX INJ 25 LF-58 MCG-10 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160081043","type":"CDM"},{"code":"90700","type":"HCPCS"},{"code":"58160081043","type":"NDC"}],"standard_charges":[{"gross_charge":379.7,"discounted_cash":265.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPH, ACELLULAR PERT & TET TOX INJ 25 LF-58 MCG-10 LF/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160081052","type":"CDM"},{"code":"90700","type":"HCPCS"},{"code":"58160081052","type":"NDC"}],"standard_charges":[{"gross_charge":339.11,"discounted_cash":237.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160082043","type":"CDM"},{"code":"90744","type":"HCPCS"},{"code":"58160082043","type":"NDC"}],"standard_charges":[{"gross_charge":205.11,"discounted_cash":143.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPATITIS B VACCINE (RECOMBINANT) SUSP PREF SYR 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) 10 MCG/0.5ML,HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160082052","type":"CDM"},{"code":"90744","type":"HCPCS"},{"code":"58160082052","type":"NDC"}],"standard_charges":[{"gross_charge":301.87,"discounted_cash":211.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2.5-18.5 LF-LF-MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160084201","type":"CDM"},{"code":"90715","type":"HCPCS"},{"code":"58160084201","type":"NDC"}],"standard_charges":[{"gross_charge":687.24,"discounted_cash":481.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2.5-18.5 LF-LF-MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160084211","type":"CDM"},{"code":"90715","type":"HCPCS"},{"code":"58160084211","type":"NDC"}],"standard_charges":[{"gross_charge":687.24,"discounted_cash":481.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160084243","type":"CDM"},{"code":"90715","type":"HCPCS"},{"code":"58160084243","type":"NDC"}],"standard_charges":[{"gross_charge":638.49,"discounted_cash":446.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx58160084252","type":"CDM"},{"code":"90715","type":"HCPCS"},{"code":"58160084252","type":"NDC"}],"standard_charges":[{"gross_charge":569.26,"discounted_cash":398.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx58657031016","type":"CDM"},{"code":"58657031016","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58657045001","type":"CDM"},{"code":"58657045001","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58657090010","type":"CDM"},{"code":"58657090010","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICYCLOMINE HCL INJ 10 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx58914008052","type":"CDM"},{"code":"J0500","type":"HCPCS"},{"code":"58914008052","type":"NDC"}],"standard_charges":[{"gross_charge":996.23,"discounted_cash":697.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCERIN SUPPOS 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx58980041012","type":"CDM"},{"code":"58980041012","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011041020","type":"CDM"},{"code":"59011041020","type":"NDC"}],"standard_charges":[{"gross_charge":19.71,"discounted_cash":13.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011041510","type":"CDM"},{"code":"59011041510","type":"NDC"}],"standard_charges":[{"gross_charge":23.26,"discounted_cash":16.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011041520","type":"CDM"},{"code":"59011041520","type":"NDC"}],"standard_charges":[{"gross_charge":23.56,"discounted_cash":16.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011042020","type":"CDM"},{"code":"59011042020","type":"NDC"}],"standard_charges":[{"gross_charge":26.77,"discounted_cash":18.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB ER 12HR DETER 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59011044020","type":"CDM"},{"code":"59011044020","type":"NDC"}],"standard_charges":[{"gross_charge":37.61,"discounted_cash":26.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59148000813","type":"CDM"},{"code":"59148000813","type":"NDC"}],"standard_charges":[{"gross_charge":43.47,"discounted_cash":30.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":8.5,"type":"GM"},"code_information":[{"code":"Rx59310057922","type":"CDM"},{"code":"59310057922","type":"NDC"}],"standard_charges":[{"gross_charge":245.52,"discounted_cash":171.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FERUMOXYTOL INJ 510 MG/17ML (30 MG/ML) (ELEMENTAL FE)","drug_information":{"unit":17.0,"type":"ML"},"code_information":[{"code":"Rx59338077501","type":"CDM"},{"code":"Q0138","type":"HCPCS"},{"code":"59338077501","type":"NDC"}],"standard_charges":[{"gross_charge":1744.41,"discounted_cash":1221.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYPROMELLOSE GONIOSCOPIC SOLN 2.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx59390018213","type":"CDM"},{"code":"59390018213","type":"NDC"}],"standard_charges":[{"gross_charge":6.54,"discounted_cash":4.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CANDIDA ALBICANS SKIN TEST ANTIGEN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx59584013801","type":"CDM"},{"code":"86485","type":"HCPCS"},{"code":"59584013801","type":"NDC"}],"standard_charges":[{"gross_charge":469.28,"discounted_cash":328.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651029501","type":"CDM"},{"code":"59651029501","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651045601","type":"CDM"},{"code":"59651045601","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59651086601","type":"CDM"},{"code":"59651086601","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPOETIN ALFA INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676031000","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676031000","type":"NDC"}],"standard_charges":[{"gross_charge":1729.58,"discounted_cash":1210.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPOETIN ALFA INJ 10000 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59676031001","type":"CDM"},{"code":"J0885","type":"HCPCS"},{"code":"59676031001","type":"NDC"}],"standard_charges":[{"gross_charge":1710.35,"discounted_cash":1197.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN (HUMAN) IM SOLN 312 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx59730420301","type":"CDM"},{"code":"90371","type":"HCPCS"},{"code":"59730420301","type":"NDC"}],"standard_charges":[{"gross_charge":2952.98,"discounted_cash":2067.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746000106","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"59746000106","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE TAB 16 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746000314","type":"CDM"},{"code":"J7509","type":"HCPCS"},{"code":"59746000314","type":"NDC"}],"standard_charges":[{"gross_charge":14.44,"discounted_cash":10.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE MALEATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746011506","type":"CDM"},{"code":"59746011506","type":"NDC"}],"standard_charges":[{"gross_charge":11.03,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746017506","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"59746017506","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746024601","type":"CDM"},{"code":"59746024601","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746028490","type":"CDM"},{"code":"59746028490","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746032430","type":"CDM"},{"code":"59746032430","type":"NDC"}],"standard_charges":[{"gross_charge":11.11,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746038306","type":"CDM"},{"code":"59746038306","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERAZOSIN HCL CAP 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59746038506","type":"CDM"},{"code":"59746038506","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762007301","type":"CDM"},{"code":"59762007301","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762015701","type":"CDM"},{"code":"59762015701","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762106101","type":"CDM"},{"code":"59762106101","type":"NDC"}],"standard_charges":[{"gross_charge":12.24,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CELECOXIB CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762151601","type":"CDM"},{"code":"59762151601","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762306003","type":"CDM"},{"code":"59762306003","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762330403","type":"CDM"},{"code":"59762330403","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx59762453701","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"59762453701","type":"NDC"}],"standard_charges":[{"gross_charge":360.77,"discounted_cash":252.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFASALAZINE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762500005","type":"CDM"},{"code":"59762500005","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762500801","type":"CDM"},{"code":"59762500801","type":"NDC"}],"standard_charges":[{"gross_charge":11.79,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx59762500802","type":"CDM"},{"code":"59762500802","type":"NDC"}],"standard_charges":[{"gross_charge":11.79,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60219107601","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"60219107601","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60219174802","type":"CDM"},{"code":"60219174802","type":"NDC"}],"standard_charges":[{"gross_charge":153.85,"discounted_cash":107.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60258000116","type":"CDM"},{"code":"60258000116","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES POWDER PACK 280-160-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60258000601","type":"CDM"},{"code":"60258000601","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES POWDER PACK 280-160-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60258000615","type":"CDM"},{"code":"60258000615","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"B-COMPLEX W/ C & FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60258016101","type":"CDM"},{"code":"60258016101","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOBETASOL PROPIONATE OINT 0.05%","drug_information":{"unit":45.0,"type":"GM"},"code_information":[{"code":"Rx60429090145","type":"CDM"},{"code":"60429090145","type":"NDC"}],"standard_charges":[{"gross_charge":182.42,"discounted_cash":127.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432006575","type":"CDM"},{"code":"60432006575","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60432012608","type":"CDM"},{"code":"60432012608","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXEPIN HCL CONC 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60432065104","type":"CDM"},{"code":"60432065104","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OMEPRAZOLE CAP DELAYED RELEASE 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505006500","type":"CDM"},{"code":"60505006500","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SOTALOL HCL TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505008000","type":"CDM"},{"code":"60505008000","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505009400","type":"CDM"},{"code":"60505009400","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB 75 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505015801","type":"CDM"},{"code":"60505015801","type":"NDC"}],"standard_charges":[{"gross_charge":11.03,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505074901","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505074901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505074904","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505074904","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505074905","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505074905","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505075901","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"60505075901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505075905","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"60505075905","type":"NDC"}],"standard_charges":[{"gross_charge":104.19,"discounted_cash":72.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505076001","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"60505076001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505076005","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"60505076005","type":"NDC"}],"standard_charges":[{"gross_charge":185.33,"discounted_cash":129.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx60505079300","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"60505079300","type":"NDC"}],"standard_charges":[{"gross_charge":111.1,"discounted_cash":77.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx60505079304","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"60505079304","type":"NDC"}],"standard_charges":[{"gross_charge":110.17,"discounted_cash":77.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx60505079501","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"60505079501","type":"NDC"}],"standard_charges":[{"gross_charge":199.82,"discounted_cash":139.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx60505079800","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"60505079800","type":"NDC"}],"standard_charges":[{"gross_charge":288.87,"discounted_cash":202.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx60505079804","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"60505079804","type":"NDC"}],"standard_charges":[{"gross_charge":286.45,"discounted_cash":200.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT","drug_information":{"unit":3.7,"type":"ML"},"code_information":[{"code":"Rx60505082306","type":"CDM"},{"code":"60505082306","type":"NDC"}],"standard_charges":[{"gross_charge":248.14,"discounted_cash":173.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT","drug_information":{"unit":16.0,"type":"GM"},"code_information":[{"code":"Rx60505082901","type":"CDM"},{"code":"60505082901","type":"NDC"}],"standard_charges":[{"gross_charge":5.72,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT","drug_information":{"unit":16.0,"type":"GM"},"code_information":[{"code":"Rx60505084703","type":"CDM"},{"code":"60505084703","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60505100301","type":"CDM"},{"code":"60505100301","type":"NDC"}],"standard_charges":[{"gross_charge":135.13,"discounted_cash":94.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60505100302","type":"CDM"},{"code":"60505100302","type":"NDC"}],"standard_charges":[{"gross_charge":219.74,"discounted_cash":153.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN TAB 800 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505255201","type":"CDM"},{"code":"60505255201","type":"NDC"}],"standard_charges":[{"gross_charge":11.48,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505257809","type":"CDM"},{"code":"60505257809","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505267403","type":"CDM"},{"code":"60505267403","type":"NDC"}],"standard_charges":[{"gross_charge":12.67,"discounted_cash":8.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505296507","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"60505296507","type":"NDC"}],"standard_charges":[{"gross_charge":13.87,"discounted_cash":9.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505311000","type":"CDM"},{"code":"60505311000","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505327500","type":"CDM"},{"code":"60505327500","type":"NDC"}],"standard_charges":[{"gross_charge":13.29,"discounted_cash":9.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505327503","type":"CDM"},{"code":"60505327503","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505327600","type":"CDM"},{"code":"60505327600","type":"NDC"}],"standard_charges":[{"gross_charge":14.68,"discounted_cash":10.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505387703","type":"CDM"},{"code":"60505387703","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505607604","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"60505607604","type":"NDC"}],"standard_charges":[{"gross_charge":107.89,"discounted_cash":75.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx60505613000","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"60505613000","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614500","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614500","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614600","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614600","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFEPIME HCL FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614604","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614604","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614700","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614700","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFEPIME HCL FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614704","type":"CDM"},{"code":"J0692","type":"HCPCS"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614900","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"60505614900","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505614904","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"60505614904","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505615700","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615700","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505615704","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505615900","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615900","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505615904","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60505616900","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"60505616900","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx60505616901","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"60505616901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505619600","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"60505619600","type":"NDC"}],"standard_charges":[{"gross_charge":937.0,"discounted_cash":655.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505619604","type":"CDM"},{"code":"J1335","type":"HCPCS"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"gross_charge":294.15,"discounted_cash":205.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505623100","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505623100","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505623105","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700600","type":"CDM"},{"code":"60505700600","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700602","type":"CDM"},{"code":"60505700602","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700700","type":"CDM"},{"code":"60505700700","type":"NDC"}],"standard_charges":[{"gross_charge":19.02,"discounted_cash":13.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700702","type":"CDM"},{"code":"60505700702","type":"NDC"}],"standard_charges":[{"gross_charge":19.02,"discounted_cash":13.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700800","type":"CDM"},{"code":"60505700800","type":"NDC"}],"standard_charges":[{"gross_charge":23.04,"discounted_cash":16.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 75 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700802","type":"CDM"},{"code":"60505700802","type":"NDC"}],"standard_charges":[{"gross_charge":23.04,"discounted_cash":16.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700900","type":"CDM"},{"code":"60505700900","type":"NDC"}],"standard_charges":[{"gross_charge":27.71,"discounted_cash":19.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505700902","type":"CDM"},{"code":"60505700902","type":"NDC"}],"standard_charges":[{"gross_charge":27.71,"discounted_cash":19.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505701202","type":"CDM"},{"code":"60505701202","type":"NDC"}],"standard_charges":[{"gross_charge":16.67,"discounted_cash":11.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 100 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505701402","type":"CDM"},{"code":"60505701402","type":"NDC"}],"standard_charges":[{"gross_charge":32.18,"discounted_cash":22.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505706100","type":"CDM"},{"code":"60505706100","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 14 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505706200","type":"CDM"},{"code":"60505706200","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 21 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505706300","type":"CDM"},{"code":"60505706300","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708000","type":"CDM"},{"code":"60505708000","type":"NDC"}],"standard_charges":[{"gross_charge":39.69,"discounted_cash":27.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 12 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708002","type":"CDM"},{"code":"60505708002","type":"NDC"}],"standard_charges":[{"gross_charge":17.11,"discounted_cash":11.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708100","type":"CDM"},{"code":"60505708100","type":"NDC"}],"standard_charges":[{"gross_charge":15.97,"discounted_cash":11.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 25 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708102","type":"CDM"},{"code":"60505708102","type":"NDC"}],"standard_charges":[{"gross_charge":19.37,"discounted_cash":13.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708200","type":"CDM"},{"code":"60505708200","type":"NDC"}],"standard_charges":[{"gross_charge":18.97,"discounted_cash":13.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL TD PATCH 72HR 50 MCG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60505708202","type":"CDM"},{"code":"60505708202","type":"NDC"}],"standard_charges":[{"gross_charge":28.35,"discounted_cash":19.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687011301","type":"CDM"},{"code":"60687011301","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONIDINE HCL TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687011311","type":"CDM"},{"code":"60687011311","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012201","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687012201","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012211","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687012211","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012811","type":"CDM"},{"code":"60687012811","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012901","type":"CDM"},{"code":"60687012901","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOCUSATE SODIUM CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687012911","type":"CDM"},{"code":"60687012911","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687013401","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687013401","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687013411","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687013411","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687014501","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687014501","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687014511","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"60687014511","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015201","type":"CDM"},{"code":"60687015201","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015211","type":"CDM"},{"code":"60687015211","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015501","type":"CDM"},{"code":"60687015501","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015511","type":"CDM"},{"code":"60687015511","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015625","type":"CDM"},{"code":"60687015625","type":"NDC"}],"standard_charges":[{"gross_charge":11.92,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN CHEW TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687015695","type":"CDM"},{"code":"60687015695","type":"NDC"}],"standard_charges":[{"gross_charge":11.92,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687016301","type":"CDM"},{"code":"60687016301","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687016311","type":"CDM"},{"code":"60687016311","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687019501","type":"CDM"},{"code":"60687019501","type":"NDC"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687019511","type":"CDM"},{"code":"60687019511","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687020601","type":"CDM"},{"code":"60687020601","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687020611","type":"CDM"},{"code":"60687020611","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021401","type":"CDM"},{"code":"60687021401","type":"NDC"}],"standard_charges":[{"gross_charge":12.02,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687021411","type":"CDM"},{"code":"60687021411","type":"NDC"}],"standard_charges":[{"gross_charge":12.02,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GEMFIBROZIL TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022411","type":"CDM"},{"code":"60687022411","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022901","type":"CDM"},{"code":"60687022901","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOPERAMIDE HCL CAP 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687022911","type":"CDM"},{"code":"60687022911","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687024201","type":"CDM"},{"code":"60687024201","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687024211","type":"CDM"},{"code":"60687024211","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687027211","type":"CDM"},{"code":"60687027211","type":"NDC"}],"standard_charges":[{"gross_charge":15.7,"discounted_cash":10.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687027294","type":"CDM"},{"code":"60687027294","type":"NDC"}],"standard_charges":[{"gross_charge":16.6,"discounted_cash":11.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687028211","type":"CDM"},{"code":"60687028211","type":"NDC"}],"standard_charges":[{"gross_charge":12.17,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687028265","type":"CDM"},{"code":"60687028265","type":"NDC"}],"standard_charges":[{"gross_charge":11.52,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687029301","type":"CDM"},{"code":"60687029301","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NORTRIPTYLINE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687029311","type":"CDM"},{"code":"60687029311","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CAPTOPRIL TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687030411","type":"CDM"},{"code":"60687030411","type":"NDC"}],"standard_charges":[{"gross_charge":12.51,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687030601","type":"CDM"},{"code":"60687030601","type":"NDC"}],"standard_charges":[{"gross_charge":11.57,"discounted_cash":8.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687030611","type":"CDM"},{"code":"60687030611","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687032511","type":"CDM"},{"code":"60687032511","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687032701","type":"CDM"},{"code":"60687032701","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687032711","type":"CDM"},{"code":"60687032711","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687033311","type":"CDM"},{"code":"60687033311","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687034501","type":"CDM"},{"code":"60687034501","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCITRIOL CAP 0.25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687034511","type":"CDM"},{"code":"60687034511","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687036901","type":"CDM"},{"code":"60687036901","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICYCLOMINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687036911","type":"CDM"},{"code":"60687036911","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037701","type":"CDM"},{"code":"60687037701","type":"NDC"}],"standard_charges":[{"gross_charge":11.99,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037711","type":"CDM"},{"code":"60687037711","type":"NDC"}],"standard_charges":[{"gross_charge":11.98,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"URSODIOL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687037895","type":"CDM"},{"code":"60687037895","type":"NDC"}],"standard_charges":[{"gross_charge":14.16,"discounted_cash":9.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038111","type":"CDM"},{"code":"60687038111","type":"NDC"}],"standard_charges":[{"gross_charge":110.68,"discounted_cash":77.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038194","type":"CDM"},{"code":"60687038194","type":"NDC"}],"standard_charges":[{"gross_charge":126.05,"discounted_cash":88.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687038911","type":"CDM"},{"code":"60687038911","type":"NDC"}],"standard_charges":[{"gross_charge":21.57,"discounted_cash":15.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687039001","type":"CDM"},{"code":"60687039001","type":"NDC"}],"standard_charges":[{"gross_charge":11.23,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687039011","type":"CDM"},{"code":"60687039011","type":"NDC"}],"standard_charges":[{"gross_charge":11.8,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040101","type":"CDM"},{"code":"60687040101","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":8.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040111","type":"CDM"},{"code":"60687040111","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687040211","type":"CDM"},{"code":"60687040211","type":"NDC"}],"standard_charges":[{"gross_charge":11.8,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx60687040579","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"60687040579","type":"NDC"}],"standard_charges":[{"gross_charge":11.01,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx60687040583","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"60687040583","type":"NDC"}],"standard_charges":[{"gross_charge":11.24,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60687041744","type":"CDM"},{"code":"60687041744","type":"NDC"}],"standard_charges":[{"gross_charge":13.53,"discounted_cash":9.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60687041771","type":"CDM"},{"code":"60687041771","type":"NDC"}],"standard_charges":[{"gross_charge":13.88,"discounted_cash":9.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687041801","type":"CDM"},{"code":"60687041801","type":"NDC"}],"standard_charges":[{"gross_charge":12.64,"discounted_cash":8.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx60687042945","type":"CDM"},{"code":"60687042945","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx60687042976","type":"CDM"},{"code":"60687042976","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043199","type":"CDM"},{"code":"60687043199","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043301","type":"CDM"},{"code":"60687043301","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMITRIPTYLINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043311","type":"CDM"},{"code":"60687043311","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043901","type":"CDM"},{"code":"60687043901","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687043911","type":"CDM"},{"code":"60687043911","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRAZODONE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044311","type":"CDM"},{"code":"60687044311","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044601","type":"CDM"},{"code":"60687044601","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687044611","type":"CDM"},{"code":"60687044611","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045301","type":"CDM"},{"code":"60687045301","type":"NDC"}],"standard_charges":[{"gross_charge":10.78,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 25 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687045311","type":"CDM"},{"code":"60687045311","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREGABALIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687047311","type":"CDM"},{"code":"60687047311","type":"NDC"}],"standard_charges":[{"gross_charge":12.56,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048111","type":"CDM"},{"code":"60687048111","type":"NDC"}],"standard_charges":[{"gross_charge":14.79,"discounted_cash":10.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPRENORPHINE HCL SL TAB 2 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048121","type":"CDM"},{"code":"60687048121","type":"NDC"}],"standard_charges":[{"gross_charge":15.34,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048401","type":"CDM"},{"code":"60687048401","type":"NDC"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687048411","type":"CDM"},{"code":"60687048411","type":"NDC"}],"standard_charges":[{"gross_charge":13.87,"discounted_cash":9.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687050301","type":"CDM"},{"code":"60687050301","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687050311","type":"CDM"},{"code":"60687050311","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 112 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687050801","type":"CDM"},{"code":"60687050801","type":"NDC"}],"standard_charges":[{"gross_charge":11.11,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60687052479","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"60687052479","type":"NDC"}],"standard_charges":[{"gross_charge":18.2,"discounted_cash":12.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUDESONIDE INHALATION SUSP 0.5 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60687052483","type":"CDM"},{"code":"J7626","type":"HCPCS"},{"code":"60687052483","type":"NDC"}],"standard_charges":[{"gross_charge":18.23,"discounted_cash":12.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687054401","type":"CDM"},{"code":"60687054401","type":"NDC"}],"standard_charges":[{"gross_charge":12.32,"discounted_cash":8.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687054411","type":"CDM"},{"code":"60687054411","type":"NDC"}],"standard_charges":[{"gross_charge":11.84,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055801","type":"CDM"},{"code":"60687055801","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687055811","type":"CDM"},{"code":"60687055811","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687056801","type":"CDM"},{"code":"60687056801","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687056811","type":"CDM"},{"code":"60687056811","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIFAMPIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687057511","type":"CDM"},{"code":"60687057511","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687057901","type":"CDM"},{"code":"60687057901","type":"NDC"}],"standard_charges":[{"gross_charge":12.15,"discounted_cash":8.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687057911","type":"CDM"},{"code":"60687057911","type":"NDC"}],"standard_charges":[{"gross_charge":11.83,"discounted_cash":8.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058001","type":"CDM"},{"code":"60687058001","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058011","type":"CDM"},{"code":"60687058011","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058311","type":"CDM"},{"code":"60687058311","type":"NDC"}],"standard_charges":[{"gross_charge":14.73,"discounted_cash":10.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687058321","type":"CDM"},{"code":"60687058321","type":"NDC"}],"standard_charges":[{"gross_charge":15.88,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059101","type":"CDM"},{"code":"60687059101","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059111","type":"CDM"},{"code":"60687059111","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059311","type":"CDM"},{"code":"60687059311","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059801","type":"CDM"},{"code":"60687059801","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPRANOLOL HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687059811","type":"CDM"},{"code":"60687059811","type":"NDC"}],"standard_charges":[{"gross_charge":10.91,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687060201","type":"CDM"},{"code":"60687060201","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687060211","type":"CDM"},{"code":"60687060211","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062001","type":"CDM"},{"code":"60687062001","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062011","type":"CDM"},{"code":"60687062011","type":"NDC"}],"standard_charges":[{"gross_charge":11.01,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062201","type":"CDM"},{"code":"60687062201","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062211","type":"CDM"},{"code":"60687062211","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062301","type":"CDM"},{"code":"60687062301","type":"NDC"}],"standard_charges":[{"gross_charge":11.95,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALSARTAN TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062311","type":"CDM"},{"code":"60687062311","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062701","type":"CDM"},{"code":"60687062701","type":"NDC"}],"standard_charges":[{"gross_charge":11.76,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687062711","type":"CDM"},{"code":"60687062711","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063011","type":"CDM"},{"code":"60687063011","type":"NDC"}],"standard_charges":[{"gross_charge":11.8,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063021","type":"CDM"},{"code":"60687063021","type":"NDC"}],"standard_charges":[{"gross_charge":12.01,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063101","type":"CDM"},{"code":"60687063101","type":"NDC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063111","type":"CDM"},{"code":"60687063111","type":"NDC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063201","type":"CDM"},{"code":"60687063201","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687063211","type":"CDM"},{"code":"60687063211","type":"NDC"}],"standard_charges":[{"gross_charge":10.82,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687064001","type":"CDM"},{"code":"60687064001","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687064011","type":"CDM"},{"code":"60687064011","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687065511","type":"CDM"},{"code":"60687065511","type":"NDC"}],"standard_charges":[{"gross_charge":11.99,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687065521","type":"CDM"},{"code":"60687065521","type":"NDC"}],"standard_charges":[{"gross_charge":11.98,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066101","type":"CDM"},{"code":"60687066101","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066111","type":"CDM"},{"code":"60687066111","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066701","type":"CDM"},{"code":"60687066701","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066711","type":"CDM"},{"code":"60687066711","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066901","type":"CDM"},{"code":"60687066901","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHIMAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687066911","type":"CDM"},{"code":"60687066911","type":"NDC"}],"standard_charges":[{"gross_charge":10.78,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067701","type":"CDM"},{"code":"60687067701","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALLOPURINOL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687067711","type":"CDM"},{"code":"60687067711","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE CAP 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687068311","type":"CDM"},{"code":"60687068311","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069501","type":"CDM"},{"code":"60687069501","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069511","type":"CDM"},{"code":"60687069511","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069911","type":"CDM"},{"code":"60687069911","type":"NDC"}],"standard_charges":[{"gross_charge":15.9,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687069921","type":"CDM"},{"code":"60687069921","type":"NDC"}],"standard_charges":[{"gross_charge":15.9,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPAFENONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687070901","type":"CDM"},{"code":"60687070901","type":"NDC"}],"standard_charges":[{"gross_charge":11.45,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPAFENONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687070911","type":"CDM"},{"code":"60687070911","type":"NDC"}],"standard_charges":[{"gross_charge":11.33,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071801","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"60687071801","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687071811","type":"CDM"},{"code":"J8540","type":"HCPCS"},{"code":"60687071811","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072801","type":"CDM"},{"code":"60687072801","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687072811","type":"CDM"},{"code":"60687072811","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687073401","type":"CDM"},{"code":"60687073401","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687074211","type":"CDM"},{"code":"60687074211","type":"NDC"}],"standard_charges":[{"gross_charge":11.88,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687074265","type":"CDM"},{"code":"60687074265","type":"NDC"}],"standard_charges":[{"gross_charge":11.53,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687074611","type":"CDM"},{"code":"60687074611","type":"NDC"}],"standard_charges":[{"gross_charge":14.01,"discounted_cash":9.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687079501","type":"CDM"},{"code":"60687079501","type":"NDC"}],"standard_charges":[{"gross_charge":11.78,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687079511","type":"CDM"},{"code":"60687079511","type":"NDC"}],"standard_charges":[{"gross_charge":11.76,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687080301","type":"CDM"},{"code":"60687080301","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687080311","type":"CDM"},{"code":"60687080311","type":"NDC"}],"standard_charges":[{"gross_charge":20.66,"discounted_cash":14.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687080701","type":"CDM"},{"code":"60687080701","type":"NDC"}],"standard_charges":[{"gross_charge":12.67,"discounted_cash":8.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHLORDIAZEPOXIDE HCL CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687080711","type":"CDM"},{"code":"60687080711","type":"NDC"}],"standard_charges":[{"gross_charge":12.67,"discounted_cash":8.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687083601","type":"CDM"},{"code":"60687083601","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687083611","type":"CDM"},{"code":"60687083611","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687084111","type":"CDM"},{"code":"60687084111","type":"NDC"}],"standard_charges":[{"gross_charge":12.43,"discounted_cash":8.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687089001","type":"CDM"},{"code":"60687089001","type":"NDC"}],"standard_charges":[{"gross_charge":13.84,"discounted_cash":9.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx60687089011","type":"CDM"},{"code":"60687089011","type":"NDC"}],"standard_charges":[{"gross_charge":13.84,"discounted_cash":9.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GENTAMICIN SULFATE OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758018805","type":"CDM"},{"code":"60758018805","type":"NDC"}],"standard_charges":[{"gross_charge":62.01,"discounted_cash":43.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758080105","type":"CDM"},{"code":"60758080105","type":"NDC"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUOROMETHOLONE OPHTH SUSP 0.1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx60758088005","type":"CDM"},{"code":"60758088005","type":"NDC"}],"standard_charges":[{"gross_charge":254.85,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 1200000 UNIT/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070102","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070102","type":"NDC"}],"standard_charges":[{"gross_charge":2186.69,"discounted_cash":1530.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN G BENZATHINE IM SUSP PREF SYR 1200000 UNIT/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx60793070110","type":"CDM"},{"code":"J0561","type":"HCPCS"},{"code":"60793070110","type":"NDC"}],"standard_charges":[{"gross_charge":2187.4,"discounted_cash":1531.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACITRACIN ZINC OINT 500 UNIT/GM","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx61269010556","type":"CDM"},{"code":"61269010556","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICONAZOLE NITRATE CREAM 2%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx61269073556","type":"CDM"},{"code":"61269073556","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPARACAINE HCL OPHTH SOLN 0.5%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314001601","type":"CDM"},{"code":"61314001601","type":"NDC"}],"standard_charges":[{"gross_charge":131.23,"discounted_cash":91.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DORZOLAMIDE HCL OPHTH SOLN 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314001910","type":"CDM"},{"code":"61314001910","type":"NDC"}],"standard_charges":[{"gross_charge":79.26,"discounted_cash":55.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314014305","type":"CDM"},{"code":"61314014305","type":"NDC"}],"standard_charges":[{"gross_charge":66.33,"discounted_cash":46.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314020315","type":"CDM"},{"code":"61314020315","type":"NDC"}],"standard_charges":[{"gross_charge":163.11,"discounted_cash":114.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PILOCARPINE HCL OPHTH SOLN 4%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx61314020615","type":"CDM"},{"code":"61314020615","type":"NDC"}],"standard_charges":[{"gross_charge":174.56,"discounted_cash":122.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314022705","type":"CDM"},{"code":"61314022705","type":"NDC"}],"standard_charges":[{"gross_charge":63.24,"discounted_cash":44.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM-SNDZ SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx61314031801","type":"CDM"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031801","type":"NDC"}],"standard_charges":[{"gross_charge":1690.85,"discounted_cash":1183.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM-SNDZ SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx61314031805","type":"CDM"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031805","type":"NDC"}],"standard_charges":[{"gross_charge":1614.47,"discounted_cash":1130.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM-SNDZ SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx61314031810","type":"CDM"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031810","type":"NDC"}],"standard_charges":[{"gross_charge":1690.85,"discounted_cash":1183.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM-SNDZ SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx61314032601","type":"CDM"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032601","type":"NDC"}],"standard_charges":[{"gross_charge":853.66,"discounted_cash":597.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx61314035501","type":"CDM"},{"code":"61314035501","type":"NDC"}],"standard_charges":[{"gross_charge":77.38,"discounted_cash":54.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOPENTOLATE HCL OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx61314039601","type":"CDM"},{"code":"61314039601","type":"NDC"}],"standard_charges":[{"gross_charge":60.08,"discounted_cash":42.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx61314054701","type":"CDM"},{"code":"61314054701","type":"NDC"}],"standard_charges":[{"gross_charge":67.16,"discounted_cash":47.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx61314054703","type":"CDM"},{"code":"61314054703","type":"NDC"}],"standard_charges":[{"gross_charge":88.1,"discounted_cash":61.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx61314063136","type":"CDM"},{"code":"61314063136","type":"NDC"}],"standard_charges":[{"gross_charge":98.7,"discounted_cash":69.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GENTAMICIN SULFATE OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314063305","type":"CDM"},{"code":"61314063305","type":"NDC"}],"standard_charges":[{"gross_charge":62.61,"discounted_cash":43.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISOLONE ACETATE OPHTH SUSP 1%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314063705","type":"CDM"},{"code":"61314063705","type":"NDC"}],"standard_charges":[{"gross_charge":136.17,"discounted_cash":95.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOMYCIN-POLYMYXIN-HC OTIC SUSP 3.5 MG/ML-10000 UNIT/ML-1%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61314064511","type":"CDM"},{"code":"61314064511","type":"NDC"}],"standard_charges":[{"gross_charge":275.21,"discounted_cash":192.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"APRACLONIDINE HCL OPHTH SOLN 0.5% (BASE EQUIVALENT)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx61314066505","type":"CDM"},{"code":"61314066505","type":"NDC"}],"standard_charges":[{"gross_charge":169.6,"discounted_cash":118.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61442012101","type":"CDM"},{"code":"61442012101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARISOPRODOL TAB 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61442045101","type":"CDM"},{"code":"61442045101","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":8.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENTANYL 50 MCG/ML PCA/INFUSION,FENTANYL CITRATE IV SOLN 2500 MCG/50ML,FENTANYL CITRATE IV SOLN 5000 MCG/100ML,FENTANYL CITRATE INJ 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2750 MCG/55ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2500 MCG/50ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1000 MCG/20ML,FENTANYL CITRATE IV SOLN 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1250 MCG/25ML,FENTANYL CITRATE-NACL SOLN PREF SYR 2500 MCG/50ML-0.9%,FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/50ML,FENTANYL CITRATE-NACL 0.9% IV SOLN 5 MG/100ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx61553052569","type":"CDM"},{"code":"J3010","type":"HCPCS"},{"code":"61553052569","type":"NDC"}],"standard_charges":[{"gross_charge":442.68,"discounted_cash":309.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx61570013150","type":"CDM"},{"code":"61570013150","type":"NDC"}],"standard_charges":[{"gross_charge":73.81,"discounted_cash":51.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PAMIDRONATE DISODIUM IV SOLN 3 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx61703032418","type":"CDM"},{"code":"J2430","type":"HCPCS"},{"code":"61703032418","type":"NDC"}],"standard_charges":[{"gross_charge":209.72,"discounted_cash":146.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EMTRICITABINE-TENOFOVIR DISOPROXIL FUMARATE TAB 200-300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958070101","type":"CDM"},{"code":"61958070101","type":"NDC"}],"standard_charges":[{"gross_charge":115.41,"discounted_cash":80.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"REMDESIVIR FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61958290101","type":"CDM"},{"code":"J0248","type":"HCPCS"},{"code":"61958290101","type":"NDC"}],"standard_charges":[{"gross_charge":2121.6,"discounted_cash":1485.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx61990012001","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"61990012001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE POLACRILEX GUM 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62011004702","type":"CDM"},{"code":"62011004702","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62135030801","type":"CDM"},{"code":"62135030801","type":"NDC"}],"standard_charges":[{"gross_charge":15.15,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62175011937","type":"CDM"},{"code":"62175011937","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE-KETOROLAC INTRAOCULAR SOLN 1-0.3%","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx62225060004","type":"CDM"},{"code":"J1097","type":"HCPCS"},{"code":"62225060004","type":"NDC"}],"standard_charges":[{"gross_charge":888.34,"discounted_cash":621.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TALC INTRAPLEURAL POWDER 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62327044404","type":"CDM"},{"code":"62327044404","type":"NDC"}],"standard_charges":[{"gross_charge":1163.7,"discounted_cash":814.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TALC INTRAPLEURAL POWDER 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62327044444","type":"CDM"},{"code":"62327044444","type":"NDC"}],"standard_charges":[{"gross_charge":1810.2,"discounted_cash":1267.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THEOPHYLLINE TAB ER 12HR 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62332002531","type":"CDM"},{"code":"62332002531","type":"NDC"}],"standard_charges":[{"gross_charge":11.79,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx62332051805","type":"CDM"},{"code":"62332051805","type":"NDC"}],"standard_charges":[{"gross_charge":70.7,"discounted_cash":49.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%","drug_information":{"unit":5.0,"type":"GM"},"code_information":[{"code":"Rx62332058204","type":"CDM"},{"code":"62332058204","type":"NDC"}],"standard_charges":[{"gross_charge":72.29,"discounted_cash":50.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"UREA PACKET 15 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62530000011","type":"CDM"},{"code":"62530000011","type":"NDC"}],"standard_charges":[{"gross_charge":4.6,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLECAINIDE ACETATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559038001","type":"CDM"},{"code":"62559038001","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559039020","type":"CDM"},{"code":"62559039020","type":"NDC"}],"standard_charges":[{"gross_charge":14.46,"discounted_cash":10.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYOSCYAMINE SULFATE TAB DISINT 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559042201","type":"CDM"},{"code":"62559042201","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INDAPAMIDE TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559051101","type":"CDM"},{"code":"62559051101","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THYROID TAB 60 MG (1 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62559074201","type":"CDM"},{"code":"62559074201","type":"NDC"}],"standard_charges":[{"gross_charge":11.29,"discounted_cash":7.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584025901","type":"CDM"},{"code":"62584025901","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026501","type":"CDM"},{"code":"62584026501","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584026511","type":"CDM"},{"code":"62584026511","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584089701","type":"CDM"},{"code":"62584089701","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOLIC ACID TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584089711","type":"CDM"},{"code":"62584089711","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584098401","type":"CDM"},{"code":"62584098401","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584098411","type":"CDM"},{"code":"62584098411","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584099401","type":"CDM"},{"code":"62584099401","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62584099411","type":"CDM"},{"code":"62584099411","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756012940","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"62756012940","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756012944","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"62756012944","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756035660","type":"CDM"},{"code":"Q0162","type":"HCPCS"},{"code":"62756035660","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756051240","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"62756051240","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756051244","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"62756051244","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 10-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756051788","type":"CDM"},{"code":"62756051788","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756051888","type":"CDM"},{"code":"62756051888","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62756075160","type":"CDM"},{"code":"62756075160","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TELAVANCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62847000101","type":"CDM"},{"code":"J3095","type":"HCPCS"},{"code":"62847000101","type":"NDC"}],"standard_charges":[{"gross_charge":1857.46,"discounted_cash":1300.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RABEPRAZOLE SODIUM EC TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx62856024330","type":"CDM"},{"code":"62856024330","type":"NDC"}],"standard_charges":[{"gross_charge":43.05,"discounted_cash":30.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TALC INTRAPLEURAL POWDER FOR SUSP 5 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63256020005","type":"CDM"},{"code":"63256020005","type":"NDC"}],"standard_charges":[{"gross_charge":1364.11,"discounted_cash":954.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MESALAMINE CAP ER 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63304008913","type":"CDM"},{"code":"63304008913","type":"NDC"}],"standard_charges":[{"gross_charge":19.49,"discounted_cash":13.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323001001","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323001001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323001002","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GENTAMICIN SULFATE INJ 40 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323001003","type":"CDM"},{"code":"J1580","type":"HCPCS"},{"code":"63323001003","type":"NDC"}],"standard_charges":[{"gross_charge":318.31,"discounted_cash":222.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001201","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001203","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001203","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001207","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001207","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001212","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001212","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYTOCIN INJ 10 UNIT/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001217","type":"CDM"},{"code":"J2590","type":"HCPCS"},{"code":"63323001217","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001301","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"63323001301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001302","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"63323001302","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323001321","type":"CDM"},{"code":"J3411","type":"HCPCS"},{"code":"63323001321","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx63323004400","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"63323004400","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323004401","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"63323004401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006401","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006402","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006402","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006403","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006403","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE INJ 50%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323006404","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323006404","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010600","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010600","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323010602","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010602","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323010605","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010605","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010800","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010800","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323010801","type":"CDM"},{"code":"J3475","type":"HCPCS"},{"code":"63323010801","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013002","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"63323013002","type":"NDC"}],"standard_charges":[{"gross_charge":297.1,"discounted_cash":207.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013011","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"63323013011","type":"NDC"}],"standard_charges":[{"gross_charge":240.32,"discounted_cash":168.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323013013","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"63323013013","type":"NDC"}],"standard_charges":[{"gross_charge":240.32,"discounted_cash":168.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323016100","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016100","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323016101","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016200","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016200","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016201","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016202","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016202","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016212","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016212","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE IM INJ 60 MG/2ML (30 MG/ML)","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016214","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016214","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx63323016223","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"63323016223","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 20 MEQ/5ML (NA),SODIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 60 MEQ/15ML (NA),SODIUM PHOSPHATES INJ 150 MM/50ML (PHOS) 200 MEQ/50ML (NA)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323017005","type":"CDM"},{"code":"63323017005","type":"NDC"}],"standard_charges":[{"gross_charge":237.06,"discounted_cash":165.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PYRIDOXINE HCL INJ 100 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323018000","type":"CDM"},{"code":"J3415","type":"HCPCS"},{"code":"63323018000","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PYRIDOXINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323018001","type":"CDM"},{"code":"J3415","type":"HCPCS"},{"code":"63323018001","type":"NDC"}],"standard_charges":[{"gross_charge":176.49,"discounted_cash":123.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOLIC ACID INJ 5 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323018410","type":"CDM"},{"code":"J1808","type":"HCPCS"},{"code":"63323018410","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WATER FOR INJECTION","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323018510","type":"CDM"},{"code":"63323018510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323018601","type":"CDM"},{"code":"63323018601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323018610","type":"CDM"},{"code":"63323018610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323018730","type":"CDM"},{"code":"63323018730","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323020102","type":"CDM"},{"code":"63323020102","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323020103","type":"CDM"},{"code":"63323020103","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323020110","type":"CDM"},{"code":"63323020110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022905","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022905","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022915","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022915","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022930","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022930","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROTAMINE SULFATE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323022935","type":"CDM"},{"code":"J2720","type":"HCPCS"},{"code":"63323022935","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFAZOLIN SODIUM FOR INJ 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323023610","type":"CDM"},{"code":"J0690","type":"HCPCS"},{"code":"63323023610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026201","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026203","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026203","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026206","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026206","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026209","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026209","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323026255","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323026255","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323026929","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323026929","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63323026950","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026950","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323026965","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026965","type":"NDC"}],"standard_charges":[{"gross_charge":146.28,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323026967","type":"CDM"},{"code":"J2704","type":"HCPCS"},{"code":"63323026967","type":"NDC"}],"standard_charges":[{"gross_charge":146.28,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323027301","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"63323027301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323028003","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"63323028003","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323028004","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"63323028004","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323028420","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"63323028420","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028631","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028631","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROPIVACAINE HCL INJ 5 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323028695","type":"CDM"},{"code":"J2795","type":"HCPCS"},{"code":"63323028695","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323029427","type":"CDM"},{"code":"J0670","type":"HCPCS"},{"code":"63323029427","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323030602","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 1.2 GM/30ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx63323030630","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"63323030630","type":"NDC"}],"standard_charges":[{"gross_charge":179.82,"discounted_cash":125.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323031119","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323031119","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMIPENEM-CILASTATIN INTRAVENOUS FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323032225","type":"CDM"},{"code":"J0743","type":"HCPCS"},{"code":"63323032225","type":"NDC"}],"standard_charges":[{"gross_charge":155.5,"discounted_cash":108.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323032509","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"63323032509","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323032510","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"63323032510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR SODIUM IV SOLN 50 MG/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323032520","type":"CDM"},{"code":"J0133","type":"HCPCS"},{"code":"63323032520","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFOXITIN SODIUM FOR IV SOLN 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323034225","type":"CDM"},{"code":"J0694","type":"HCPCS"},{"code":"63323034225","type":"NDC"}],"standard_charges":[{"gross_charge":203.29,"discounted_cash":142.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323034720","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"63323034720","type":"NDC"}],"standard_charges":[{"gross_charge":114.43,"discounted_cash":80.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323036001","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323036001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323036019","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"63323036019","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323037601","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323037601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 200 MCG/ML (0.2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323037805","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"63323037805","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323039810","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"63323039810","type":"NDC"}],"standard_charges":[{"gross_charge":108.13,"discounted_cash":75.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323039812","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"63323039812","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040101","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040101","type":"NDC"}],"standard_charges":[{"gross_charge":397.07,"discounted_cash":277.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZTREONAM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040120","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040120","type":"NDC"}],"standard_charges":[{"gross_charge":321.64,"discounted_cash":225.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040201","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040201","type":"NDC"}],"standard_charges":[{"gross_charge":793.77,"discounted_cash":555.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040203","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040203","type":"NDC"}],"standard_charges":[{"gross_charge":794.28,"discounted_cash":556.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040220","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040220","type":"NDC"}],"standard_charges":[{"gross_charge":656.84,"discounted_cash":459.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZTREONAM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323040230","type":"CDM"},{"code":"J0457","type":"HCPCS"},{"code":"63323040230","type":"NDC"}],"standard_charges":[{"gross_charge":656.84,"discounted_cash":459.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323040302","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040302","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323040310","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323041110","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"63323041110","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323041113","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"63323041113","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323042405","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"63323042405","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN IV SOLN 10 MG/ML","drug_information":{"unit":65.0,"type":"ML"},"code_information":[{"code":"Rx63323043441","type":"CDM"},{"code":"J0134","type":"HCPCS"},{"code":"63323043441","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046201","type":"CDM"},{"code":"63323046201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046217","type":"CDM"},{"code":"63323046217","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046237","type":"CDM"},{"code":"63323046237","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046437","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046437","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046617","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046617","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046637","type":"CDM"},{"code":"J0665","type":"HCPCS"},{"code":"63323046637","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPIVACAINE INJ 0.25% W/ EPINEPHRINE 1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323046817","type":"CDM"},{"code":"63323046817","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL DECANOATE IM SOLN 100 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323047101","type":"CDM"},{"code":"J1631","type":"HCPCS"},{"code":"63323047101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323047400","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"63323047400","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323047401","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"63323047401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048201","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048203","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048203","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048227","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048227","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048527","type":"CDM"},{"code":"63323048527","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048627","type":"CDM"},{"code":"63323048627","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323048717","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048717","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323048921","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048921","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE INJ 2% W/ EPINEPHRINE-1:200000 (PF)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323048927","type":"CDM"},{"code":"J2004","type":"HCPCS"},{"code":"63323048927","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323049157","type":"CDM"},{"code":"63323049157","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049227","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049227","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049257","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049257","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049297","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"63323049297","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323049401","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"63323049401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323049405","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"63323049405","type":"NDC"}],"standard_charges":[{"gross_charge":106.53,"discounted_cash":74.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049507","type":"CDM"},{"code":"63323049507","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323049697","type":"CDM"},{"code":"63323049697","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050701","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050720","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050720","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050721","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050721","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050830","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050830","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323050831","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"63323050831","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx63323051701","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323051701","type":"NDC"}],"standard_charges":[{"gross_charge":159.3,"discounted_cash":111.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SOD (PORCINE) IN NACL IV SOLN 25000 UNIT/250ML-0.45%","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx63323051774","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323051774","type":"NDC"}],"standard_charges":[{"gross_charge":159.3,"discounted_cash":111.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx63323053101","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323053101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323053301","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323053301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323053383","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323053383","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323053501","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323053501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323053508","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323053508","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323053587","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323053587","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054007","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054007","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054011","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054011","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054015","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054015","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054057","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054057","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323054067","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63323054067","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323055921","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323055921","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323055965","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323055965","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323055993","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323055993","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056421","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056421","type":"NDC"}],"standard_charges":[{"gross_charge":117.4,"discounted_cash":82.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056463","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056463","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056465","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056465","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056497","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056497","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323056621","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056621","type":"NDC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":102.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323056698","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056698","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx63323056883","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056883","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323056884","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056884","type":"NDC"}],"standard_charges":[{"gross_charge":121.66,"discounted_cash":85.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056887","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056887","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx63323056896","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056896","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx63323056984","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323056984","type":"NDC"}],"standard_charges":[{"gross_charge":175.99,"discounted_cash":123.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE INJ 8 MG/20ML (0.4 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323058003","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"63323058003","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE INJ 8 MG/20ML (0.4 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63323058020","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"63323058020","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx63323058421","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058421","type":"NDC"}],"standard_charges":[{"gross_charge":204.44,"discounted_cash":143.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx63323058621","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323058621","type":"NDC"}],"standard_charges":[{"gross_charge":262.91,"discounted_cash":184.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLUCAGON HCL DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323059603","type":"CDM"},{"code":"J1611","type":"HCPCS"},{"code":"63323059603","type":"NDC"}],"standard_charges":[{"gross_charge":1368.89,"discounted_cash":958.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323061400","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061400","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323061401","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323061421","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061421","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDRALAZINE HCL INJ 20 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323061455","type":"CDM"},{"code":"J0360","type":"HCPCS"},{"code":"63323061455","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx63323061603","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"63323061603","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323064907","type":"CDM"},{"code":"J0651","type":"HCPCS"},{"code":"63323064907","type":"NDC"}],"standard_charges":[{"gross_charge":996.38,"discounted_cash":697.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323064916","type":"CDM"},{"code":"J0650","type":"HCPCS"},{"code":"63323064916","type":"NDC"}],"standard_charges":[{"gross_charge":996.38,"discounted_cash":697.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323065210","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"63323065210","type":"NDC"}],"standard_charges":[{"gross_charge":261.71,"discounted_cash":183.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx63323065521","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323065521","type":"NDC"}],"standard_charges":[{"gross_charge":321.26,"discounted_cash":224.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx63323065599","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"63323065599","type":"NDC"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":84.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323066401","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"63323066401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERBUTALINE SULFATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323066500","type":"CDM"},{"code":"J3105","type":"HCPCS"},{"code":"63323066500","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TERBUTALINE SULFATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323066501","type":"CDM"},{"code":"J3105","type":"HCPCS"},{"code":"63323066501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INHAL SOLN 10%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx63323069130","type":"CDM"},{"code":"J7608","type":"HCPCS"},{"code":"63323069130","type":"NDC"}],"standard_charges":[{"gross_charge":12.83,"discounted_cash":8.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323072901","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"63323072901","type":"NDC"}],"standard_charges":[{"gross_charge":692.52,"discounted_cash":484.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MICAFUNGIN SODIUM FOR IV SOLN 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323072910","type":"CDM"},{"code":"J2248","type":"HCPCS"},{"code":"63323072910","type":"NDC"}],"standard_charges":[{"gross_charge":445.82,"discounted_cash":312.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE INJ 40 MG/4ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323073809","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"63323073809","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323073912","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"63323073912","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323075100","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"63323075100","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323075101","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"63323075101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 10%","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx63323082425","type":"CDM"},{"code":"63323082425","type":"NDC"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":103.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63323085225","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"63323085225","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63323087115","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"63323087115","type":"NDC"}],"standard_charges":[{"gross_charge":332.62,"discounted_cash":232.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM IV SOLN 100 MCG/5ML (20 MCG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323088510","type":"CDM"},{"code":"J0651","type":"HCPCS"},{"code":"63323088510","type":"NDC"}],"standard_charges":[{"gross_charge":1039.86,"discounted_cash":727.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM IV SOLN 100 MCG/5ML (20 MCG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323088514","type":"CDM"},{"code":"J0651","type":"HCPCS"},{"code":"63323088514","type":"NDC"}],"standard_charges":[{"gross_charge":1039.86,"discounted_cash":727.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323093000","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"63323093000","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx63323093001","type":"CDM"},{"code":"J2598","type":"HCPCS"},{"code":"63323093001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323096501","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx63323096505","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096505","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63323096510","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE INJ 2 MEQ/ML","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx63323096520","type":"CDM"},{"code":"J3480","type":"HCPCS"},{"code":"63323096520","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx63323096600","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"63323096600","type":"NDC"}],"standard_charges":[{"gross_charge":663.49,"discounted_cash":464.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZTROPINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx63323097002","type":"CDM"},{"code":"J0515","type":"HCPCS"},{"code":"63323097002","type":"NDC"}],"standard_charges":[{"gross_charge":143.91,"discounted_cash":100.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LURASIDONE HCL TAB 40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63402030430","type":"CDM"},{"code":"63402030430","type":"NDC"}],"standard_charges":[{"gross_charge":88.74,"discounted_cash":62.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVALBUTEROL TARTRATE INHAL AEROSOL 45 MCG/ACT (BASE EQUIV)","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx63402051001","type":"CDM"},{"code":"63402051001","type":"NDC"}],"standard_charges":[{"gross_charge":170.02,"discounted_cash":119.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63402051500","type":"CDM"},{"code":"J7612","type":"HCPCS"},{"code":"63402051500","type":"NDC"}],"standard_charges":[{"gross_charge":19.59,"discounted_cash":13.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RITUXIMAB-ABBS IV SOLN 100 MG/10ML (10 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx63459010310","type":"CDM"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010310","type":"NDC"}],"standard_charges":[{"gross_charge":2210.51,"discounted_cash":1547.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RITUXIMAB-ABBS IV SOLN 500 MG/50ML (10 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx63459010450","type":"CDM"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010450","type":"NDC"}],"standard_charges":[{"gross_charge":9974.64,"discounted_cash":6982.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TBO-FILGRASTIM SOLN PREFILLED SYRINGE 300 MCG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx63459091011","type":"CDM"},{"code":"J1447","type":"HCPCS"},{"code":"63459091011","type":"NDC"}],"standard_charges":[{"gross_charge":1629.18,"discounted_cash":1140.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TBO-FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx63459091211","type":"CDM"},{"code":"J1447","type":"HCPCS"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"gross_charge":822.52,"discounted_cash":575.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TBO-FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx63459091212","type":"CDM"},{"code":"J1447","type":"HCPCS"},{"code":"63459091212","type":"NDC"}],"standard_charges":[{"gross_charge":831.74,"discounted_cash":582.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63481068706","type":"CDM"},{"code":"63481068706","type":"NDC"}],"standard_charges":[{"gross_charge":51.79,"discounted_cash":36.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PERMETHRIN CREME RINSE 1%","drug_information":{"unit":59.0,"type":"ML"},"code_information":[{"code":"Rx63736012003","type":"CDM"},{"code":"63736012003","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":6.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx63736014308","type":"CDM"},{"code":"63736014308","type":"NDC"}],"standard_charges":[{"gross_charge":7.94,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739001410","type":"CDM"},{"code":"63739001410","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739001510","type":"CDM"},{"code":"63739001510","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739002910","type":"CDM"},{"code":"63739002910","type":"NDC"}],"standard_charges":[{"gross_charge":10.91,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739003807","type":"CDM"},{"code":"63739003807","type":"NDC"}],"standard_charges":[{"gross_charge":28.08,"discounted_cash":19.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARISOPRODOL TAB 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739004910","type":"CDM"},{"code":"63739004910","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":8.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739005910","type":"CDM"},{"code":"63739005910","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739007310","type":"CDM"},{"code":"63739007310","type":"NDC"}],"standard_charges":[{"gross_charge":11.61,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL TAB 60 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739008010","type":"CDM"},{"code":"63739008010","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN TAB 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739008702","type":"CDM"},{"code":"63739008702","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739010310","type":"CDM"},{"code":"63739010310","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDRALAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739012610","type":"CDM"},{"code":"63739012610","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739012810","type":"CDM"},{"code":"63739012810","type":"NDC"}],"standard_charges":[{"gross_charge":10.16,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739017910","type":"CDM"},{"code":"63739017910","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOBARBITAL TAB 32.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739020110","type":"CDM"},{"code":"63739020110","type":"NDC"}],"standard_charges":[{"gross_charge":12.22,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739021202","type":"CDM"},{"code":"63739021202","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739022510","type":"CDM"},{"code":"63739022510","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739022810","type":"CDM"},{"code":"63739022810","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739023110","type":"CDM"},{"code":"63739023110","type":"NDC"}],"standard_charges":[{"gross_charge":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739023610","type":"CDM"},{"code":"63739023610","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739026310","type":"CDM"},{"code":"63739026310","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":8.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TAMOXIFEN CITRATE TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739026910","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"63739026910","type":"NDC"}],"standard_charges":[{"gross_charge":10.78,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739028310","type":"CDM"},{"code":"63739028310","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739029310","type":"CDM"},{"code":"63739029310","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739032601","type":"CDM"},{"code":"63739032601","type":"NDC"}],"standard_charges":[{"gross_charge":12.04,"discounted_cash":8.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739034910","type":"CDM"},{"code":"63739034910","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739035010","type":"CDM"},{"code":"63739035010","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM OXIDE TAB 400 MG (240 MG ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739035410","type":"CDM"},{"code":"63739035410","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739043202","type":"CDM"},{"code":"63739043202","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739043210","type":"CDM"},{"code":"63739043210","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739043401","type":"CDM"},{"code":"63739043401","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739044610","type":"CDM"},{"code":"63739044610","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739047910","type":"CDM"},{"code":"63739047910","type":"NDC"}],"standard_charges":[{"gross_charge":10.91,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739049910","type":"CDM"},{"code":"63739049910","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROPAFENONE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739050910","type":"CDM"},{"code":"63739050910","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739051910","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"63739051910","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739052010","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"63739052010","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739052301","type":"CDM"},{"code":"63739052301","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739052510","type":"CDM"},{"code":"63739052510","type":"NDC"}],"standard_charges":[{"gross_charge":15.68,"discounted_cash":10.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739054410","type":"CDM"},{"code":"63739054410","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739056410","type":"CDM"},{"code":"63739056410","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739058810","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"63739058810","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739059110","type":"CDM"},{"code":"63739059110","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739064510","type":"CDM"},{"code":"63739064510","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DONEPEZIL HYDROCHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739064610","type":"CDM"},{"code":"63739064610","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"QUETIAPINE FUMARATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739066510","type":"CDM"},{"code":"63739066510","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739066910","type":"CDM"},{"code":"63739066910","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067010","type":"CDM"},{"code":"63739067010","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067210","type":"CDM"},{"code":"63739067210","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739067310","type":"CDM"},{"code":"63739067310","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739069310","type":"CDM"},{"code":"63739069310","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739070010","type":"CDM"},{"code":"63739070010","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739070110","type":"CDM"},{"code":"63739070110","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739070410","type":"CDM"},{"code":"63739070410","type":"NDC"}],"standard_charges":[{"gross_charge":12.27,"discounted_cash":8.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GALANTAMINE HYDROBROMIDE TAB 8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739070833","type":"CDM"},{"code":"63739070833","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739071410","type":"CDM"},{"code":"63739071410","type":"NDC"}],"standard_charges":[{"gross_charge":11.17,"discounted_cash":7.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TEMAZEPAM CAP 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739087710","type":"CDM"},{"code":"63739087710","type":"NDC"}],"standard_charges":[{"gross_charge":11.69,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739090210","type":"CDM"},{"code":"63739090210","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739090310","type":"CDM"},{"code":"63739090310","type":"NDC"}],"standard_charges":[{"gross_charge":10.33,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739094310","type":"CDM"},{"code":"63739094310","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx63739095311","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"63739095311","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739097210","type":"CDM"},{"code":"63739097210","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63739098410","type":"CDM"},{"code":"63739098410","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN TAB ER 12HR 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63824000815","type":"CDM"},{"code":"63824000815","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN TAB ER 12HR 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx63824000834","type":"CDM"},{"code":"63824000834","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROMETHORPHAN POLISTIREX EXTENDED RELEASE SUSP 30 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx63824017163","type":"CDM"},{"code":"63824017163","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 10 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx64253022235","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"64253022235","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) LOCK FLUSH PF IV SOLN 100 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx64253033335","type":"CDM"},{"code":"J1642","type":"HCPCS"},{"code":"64253033335","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx64253090030","type":"CDM"},{"code":"64253090030","type":"NDC"}],"standard_charges":[{"gross_charge":117.97,"discounted_cash":82.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx64253090091","type":"CDM"},{"code":"64253090091","type":"NDC"}],"standard_charges":[{"gross_charge":112.89,"discounted_cash":79.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMIPRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380017001","type":"CDM"},{"code":"64380017001","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380073706","type":"CDM"},{"code":"64380073706","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUSPIRONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380074106","type":"CDM"},{"code":"64380074106","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREDNISONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380078206","type":"CDM"},{"code":"J7512","type":"HCPCS"},{"code":"64380078206","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64380079901","type":"CDM"},{"code":"64380079901","type":"NDC"}],"standard_charges":[{"gross_charge":13.33,"discounted_cash":9.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679005601","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"64679005601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679005602","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"64679005602","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx64679072801","type":"CDM"},{"code":"J3030","type":"HCPCS"},{"code":"64679072801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679098301","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"64679098301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64679098302","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"64679098302","type":"NDC"}],"standard_charges":[{"gross_charge":103.93,"discounted_cash":72.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764011907","type":"CDM"},{"code":"64764011907","type":"NDC"}],"standard_charges":[{"gross_charge":22.45,"discounted_cash":15.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VEDOLIZUMAB FOR IV SOLUTION 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764030020","type":"CDM"},{"code":"J3380","type":"HCPCS"},{"code":"64764030020","type":"NDC"}],"standard_charges":[{"gross_charge":37997.48,"discounted_cash":26598.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIOGLITAZONE HCL TAB 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64764030114","type":"CDM"},{"code":"64764030114","type":"NDC"}],"standard_charges":[{"gross_charge":44.04,"discounted_cash":30.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64850050501","type":"CDM"},{"code":"64850050501","type":"NDC"}],"standard_charges":[{"gross_charge":11.94,"discounted_cash":8.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE CAP ER 24HR 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64850051401","type":"CDM"},{"code":"64850051401","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPYRIDAMOLE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980013301","type":"CDM"},{"code":"64980013301","type":"NDC"}],"standard_charges":[{"gross_charge":12.14,"discounted_cash":8.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980015701","type":"CDM"},{"code":"64980015701","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARISOPRODOL TAB 350 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980017401","type":"CDM"},{"code":"64980017401","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MENTHOL-ZINC OXIDE OINT 0.44-20.625%","drug_information":{"unit":113.0,"type":"GM"},"code_information":[{"code":"Rx64980032212","type":"CDM"},{"code":"64980032212","type":"NDC"}],"standard_charges":[{"gross_charge":3.27,"discounted_cash":2.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE PERIANAL CREAM 2.5%","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx64980032430","type":"CDM"},{"code":"64980032430","type":"NDC"}],"standard_charges":[{"gross_charge":74.76,"discounted_cash":52.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FINGOLIMOD HCL CAP 0.5 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980044903","type":"CDM"},{"code":"64980044903","type":"NDC"}],"standard_charges":[{"gross_charge":24.61,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TIMOLOL MALEATE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx64980051405","type":"CDM"},{"code":"64980051405","type":"NDC"}],"standard_charges":[{"gross_charge":76.46,"discounted_cash":53.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx64980056401","type":"CDM"},{"code":"64980056401","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162018810","type":"CDM"},{"code":"65162018810","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEMECLOCYCLINE HCL TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162055410","type":"CDM"},{"code":"65162055410","type":"NDC"}],"standard_charges":[{"gross_charge":21.05,"discounted_cash":14.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162068110","type":"CDM"},{"code":"65162068110","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DUTASTERIDE CAP 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162075003","type":"CDM"},{"code":"65162075003","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162079104","type":"CDM"},{"code":"65162079104","type":"NDC"}],"standard_charges":[{"gross_charge":13.6,"discounted_cash":9.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162079108","type":"CDM"},{"code":"65162079108","type":"NDC"}],"standard_charges":[{"gross_charge":13.56,"discounted_cash":9.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR OINT 5%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx65162083594","type":"CDM"},{"code":"65162083594","type":"NDC"}],"standard_charges":[{"gross_charge":83.58,"discounted_cash":58.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162089703","type":"CDM"},{"code":"65162089703","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162089803","type":"CDM"},{"code":"65162089803","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65162090203","type":"CDM"},{"code":"65162090203","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMTERENE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65197000301","type":"CDM"},{"code":"65197000301","type":"NDC"}],"standard_charges":[{"gross_charge":26.84,"discounted_cash":18.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LANOLIN-PETROLATUM OINT 15.5-53.4%","drug_information":{"unit":42.5,"type":"GM"},"code_information":[{"code":"Rx65197040010","type":"CDM"},{"code":"65197040010","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LANOLIN-PETROLATUM OINT 15.5-53.4%","drug_information":{"unit":113.0,"type":"GM"},"code_information":[{"code":"Rx65197040101","type":"CDM"},{"code":"65197040101","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":2.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM GLUCONATE-NACL IV SOLN 1 GM/50ML-0.675% (20 MG/ML)","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx65219016201","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"65219016201","type":"NDC"}],"standard_charges":[{"gross_charge":253.82,"discounted_cash":177.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETAMINE HCL INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx65219018401","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"65219018401","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETAMINE HCL INJ 10 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx65219018420","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"65219018420","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETAMINE HCL INJ 100 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx65219018601","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"65219018601","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DESMOPRESSIN ACETATE INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx65219029510","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"65219029510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 5%","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx65219046405","type":"CDM"},{"code":"J7060","type":"HCPCS"},{"code":"65219046405","type":"NDC"}],"standard_charges":[{"gross_charge":147.89,"discounted_cash":103.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx65219057201","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"65219057201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx65219057210","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"65219057210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYD-LIDOCAINE-AL HYDROXIDE-MG HYDROXIDE-SIMETH","drug_information":{"unit":119.0,"type":"ML"},"code_information":[{"code":"Rx65628005004","type":"CDM"},{"code":"65628005004","type":"NDC"}],"standard_charges":[{"gross_charge":164.33,"discounted_cash":115.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LANSOPRAZOLE SUSP 3 MG/ML (COMPOUND KIT)","drug_information":{"unit":90.0,"type":"ML"},"code_information":[{"code":"Rx65628008003","type":"CDM"},{"code":"65628008003","type":"NDC"}],"standard_charges":[{"gross_charge":310.03,"discounted_cash":217.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR ORAL SOLN 50 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx65628020605","type":"CDM"},{"code":"65628020605","type":"NDC"}],"standard_charges":[{"gross_charge":13.7,"discounted_cash":9.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIFAXIMIN TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65649030103","type":"CDM"},{"code":"65649030103","type":"NDC"}],"standard_charges":[{"gross_charge":29.36,"discounted_cash":20.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIFAXIMIN TAB 550 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65649030303","type":"CDM"},{"code":"65649030303","type":"NDC"}],"standard_charges":[{"gross_charge":109.05,"discounted_cash":76.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE ACETATE SUPPOS 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65649041112","type":"CDM"},{"code":"65649041112","type":"NDC"}],"standard_charges":[{"gross_charge":21.47,"discounted_cash":15.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLNALTREXONE BROMIDE INJ 12 MG/0.6ML (20 MG/ML),METHYLNALTREXONE BROMIDE SOLN PREF SYR 12 MG/0.6ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx65649055103","type":"CDM"},{"code":"J2212","type":"HCPCS"},{"code":"65649055103","type":"NDC"}],"standard_charges":[{"gross_charge":1342.61,"discounted_cash":939.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLNALTREXONE BROMIDE INJ 12 MG/0.6ML (20 MG/ML),METHYLNALTREXONE BROMIDE SOLN PREF SYR 12 MG/0.6ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx65649055107","type":"CDM"},{"code":"J2212","type":"HCPCS"},{"code":"65649055107","type":"NDC"}],"standard_charges":[{"gross_charge":1342.56,"discounted_cash":939.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862001601","type":"CDM"},{"code":"65862001601","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862001701","type":"CDM"},{"code":"65862001701","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65862007101","type":"CDM"},{"code":"65862007101","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862007601","type":"CDM"},{"code":"65862007601","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUMATRIPTAN SUCCINATE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014736","type":"CDM"},{"code":"65862014736","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FINASTERIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862014990","type":"CDM"},{"code":"65862014990","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN V POTASSIUM TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862017501","type":"CDM"},{"code":"65862017501","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFDINIR CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862017760","type":"CDM"},{"code":"65862017760","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUOXETINE HCL CAP 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862019201","type":"CDM"},{"code":"65862019201","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862020190","type":"CDM"},{"code":"65862020190","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862020199","type":"CDM"},{"code":"65862020199","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862020290","type":"CDM"},{"code":"65862020290","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx65862021801","type":"CDM"},{"code":"65862021801","type":"NDC"}],"standard_charges":[{"gross_charge":15.46,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862039010","type":"CDM"},{"code":"65862039010","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862044830","type":"CDM"},{"code":"65862044830","type":"NDC"}],"standard_charges":[{"gross_charge":11.53,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx65862049647","type":"CDM"},{"code":"65862049647","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":8.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862050320","type":"CDM"},{"code":"65862050320","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862052730","type":"CDM"},{"code":"65862052730","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862052830","type":"CDM"},{"code":"65862052830","type":"NDC"}],"standard_charges":[{"gross_charge":10.31,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx65862053401","type":"CDM"},{"code":"65862053401","type":"NDC"}],"standard_charges":[{"gross_charge":11.29,"discounted_cash":7.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx65862053450","type":"CDM"},{"code":"65862053450","type":"NDC"}],"standard_charges":[{"gross_charge":11.43,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 600-42.9 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx65862053575","type":"CDM"},{"code":"65862053575","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862059801","type":"CDM"},{"code":"65862059801","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALPRAZOLAM TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862067601","type":"CDM"},{"code":"65862067601","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx65862069960","type":"CDM"},{"code":"65862069960","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx65862084003","type":"CDM"},{"code":"65862084003","type":"NDC"}],"standard_charges":[{"gross_charge":138.87,"discounted_cash":97.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66553000201","type":"CDM"},{"code":"66553000201","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM CARBONATE (ANTACID) CHEW TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66553000401","type":"CDM"},{"code":"66553000401","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EZETIMIBE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66582041431","type":"CDM"},{"code":"66582041431","type":"NDC"}],"standard_charges":[{"gross_charge":29.97,"discounted_cash":20.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66685100100","type":"CDM"},{"code":"66685100100","type":"NDC"}],"standard_charges":[{"gross_charge":12.06,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE TAB 875-125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66685100101","type":"CDM"},{"code":"66685100101","type":"NDC"}],"standard_charges":[{"gross_charge":12.07,"discounted_cash":8.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 200-28.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66685101101","type":"CDM"},{"code":"66685101101","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx66685101200","type":"CDM"},{"code":"66685101200","type":"NDC"}],"standard_charges":[{"gross_charge":12.99,"discounted_cash":9.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx66689000950","type":"CDM"},{"code":"66689000950","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689002301","type":"CDM"},{"code":"66689002301","type":"NDC"}],"standard_charges":[{"gross_charge":13.82,"discounted_cash":9.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689002350","type":"CDM"},{"code":"66689002350","type":"NDC"}],"standard_charges":[{"gross_charge":13.54,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL SOLN 5 MG/5ML (10 MG/10ML) (BASE EQUIV)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689003150","type":"CDM"},{"code":"66689003150","type":"NDC"}],"standard_charges":[{"gross_charge":12.44,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN SUSP 125 MG/5ML","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx66689003601","type":"CDM"},{"code":"66689003601","type":"NDC"}],"standard_charges":[{"gross_charge":12.44,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689003701","type":"CDM"},{"code":"66689003701","type":"NDC"}],"standard_charges":[{"gross_charge":11.92,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689003750","type":"CDM"},{"code":"66689003750","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689003799","type":"CDM"},{"code":"66689003799","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACTULOSE SOLUTION 10 GM/15ML","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx66689003801","type":"CDM"},{"code":"66689003801","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx66689004701","type":"CDM"},{"code":"66689004701","type":"NDC"}],"standard_charges":[{"gross_charge":16.92,"discounted_cash":11.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML)","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx66689004750","type":"CDM"},{"code":"66689004750","type":"NDC"}],"standard_charges":[{"gross_charge":12.84,"discounted_cash":8.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx66689005301","type":"CDM"},{"code":"66689005301","type":"NDC"}],"standard_charges":[{"gross_charge":9.9,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM HYDROXIDE SUSP 400 MG/5ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx66689005399","type":"CDM"},{"code":"66689005399","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx66689020108","type":"CDM"},{"code":"66689020108","type":"NDC"}],"standard_charges":[{"gross_charge":13.68,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx66689020204","type":"CDM"},{"code":"66689020204","type":"NDC"}],"standard_charges":[{"gross_charge":19.8,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHARCOAL ACTIVATED LIQ","drug_information":{"unit":120.0,"type":"ML"},"code_information":[{"code":"Rx66689020208","type":"CDM"},{"code":"66689020208","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689040101","type":"CDM"},{"code":"66689040101","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL SOLN 5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx66689040150","type":"CDM"},{"code":"66689040150","type":"NDC"}],"standard_charges":[{"gross_charge":19.82,"discounted_cash":13.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66758017006","type":"CDM"},{"code":"66758017006","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66758017013","type":"CDM"},{"code":"66758017013","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx66794020202","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"66794020202","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx66794020242","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"66794020242","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66794020741","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"66794020741","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx66794021943","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"66794021943","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML)","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"Rx66794021963","type":"CDM"},{"code":"J2020","type":"HCPCS"},{"code":"66794021963","type":"NDC"}],"standard_charges":[{"gross_charge":458.27,"discounted_cash":320.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":18.0,"type":"GM"},"code_information":[{"code":"Rx66993001968","type":"CDM"},{"code":"66993001968","type":"NDC"}],"standard_charges":[{"gross_charge":146.23,"discounted_cash":102.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx66993005702","type":"CDM"},{"code":"66993005702","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx66993089815","type":"CDM"},{"code":"66993089815","type":"NDC"}],"standard_charges":[{"gross_charge":116.62,"discounted_cash":81.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx67457015300","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"67457015300","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx67457015303","type":"CDM"},{"code":"J0282","type":"HCPCS"},{"code":"67457015303","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457018200","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"67457018200","type":"NDC"}],"standard_charges":[{"gross_charge":103.19,"discounted_cash":72.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESMOLOL HCL INJ 100 MG/10ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457018210","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"67457018210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457019800","type":"CDM"},{"code":"67457019800","type":"NDC"}],"standard_charges":[{"gross_charge":698.57,"discounted_cash":489.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"REMIFENTANIL HCL FOR IV SOLN 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457019803","type":"CDM"},{"code":"67457019803","type":"NDC"}],"standard_charges":[{"gross_charge":698.57,"discounted_cash":489.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx67457021102","type":"CDM"},{"code":"J1451","type":"HCPCS"},{"code":"67457021102","type":"NDC"}],"standard_charges":[{"gross_charge":3687.34,"discounted_cash":2581.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457025100","type":"CDM"},{"code":"67457025100","type":"NDC"}],"standard_charges":[{"gross_charge":248.16,"discounted_cash":173.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457025102","type":"CDM"},{"code":"67457025102","type":"NDC"}],"standard_charges":[{"gross_charge":169.04,"discounted_cash":118.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx67457029200","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"67457029200","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx67457029202","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"67457029202","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457033900","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457033900","type":"NDC"}],"standard_charges":[{"gross_charge":118.48,"discounted_cash":82.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457033950","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457033950","type":"NDC"}],"standard_charges":[{"gross_charge":115.72,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457034000","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457034000","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457034001","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457034810","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"67457034810","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457034903","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"67457034903","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457041900","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457041900","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457041901","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457041901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042300","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042300","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457042312","type":"CDM"},{"code":"J1100","type":"HCPCS"},{"code":"67457042312","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457042600","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"67457042600","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HALOPERIDOL LACTATE INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457042612","type":"CDM"},{"code":"J1630","type":"HCPCS"},{"code":"67457042612","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PAMIDRONATE DISODIUM IV SOLN 3 MG/ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx67457043010","type":"CDM"},{"code":"J2430","type":"HCPCS"},{"code":"67457043010","type":"NDC"}],"standard_charges":[{"gross_charge":134.19,"discounted_cash":93.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457043300","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"67457043300","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE PRESERVATIVE FREE INJ 20 MG/2ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457043322","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"67457043322","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043800","type":"CDM"},{"code":"67457043800","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VECURONIUM BROMIDE FOR INJ 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457043810","type":"CDM"},{"code":"67457043810","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE INJ 40 MG/4ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457044800","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"67457044800","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE INJ 40 MG/4ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457044843","type":"CDM"},{"code":"J1308","type":"HCPCS"},{"code":"67457044843","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457047300","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"67457047300","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457047322","type":"CDM"},{"code":"J3260","type":"HCPCS"},{"code":"67457047322","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457052200","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"67457052200","type":"NDC"}],"standard_charges":[{"gross_charge":119.07,"discounted_cash":83.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457052237","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"67457052237","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457058200","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"67457058200","type":"NDC"}],"standard_charges":[{"gross_charge":147.66,"discounted_cash":103.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 2.5 MG/0.5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx67457058210","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"67457058210","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx67457058500","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"67457058500","type":"NDC"}],"standard_charges":[{"gross_charge":471.92,"discounted_cash":330.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FONDAPARINUX SODIUM SUBCUTANEOUS INJ 10 MG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx67457058508","type":"CDM"},{"code":"J1652","type":"HCPCS"},{"code":"67457058508","type":"NDC"}],"standard_charges":[{"gross_charge":466.68,"discounted_cash":326.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457061200","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457061200","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457061310","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"67457061310","type":"NDC"}],"standard_charges":[{"gross_charge":1075.51,"discounted_cash":752.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx67457061910","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"67457061910","type":"NDC"}],"standard_charges":[{"gross_charge":919.62,"discounted_cash":643.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx67457063110","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"67457063110","type":"NDC"}],"standard_charges":[{"gross_charge":917.43,"discounted_cash":642.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx67457064500","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"67457064500","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx67457064502","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"67457064502","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"Rx67457065725","type":"CDM"},{"code":"J1805","type":"HCPCS"},{"code":"67457065725","type":"NDC"}],"standard_charges":[{"gross_charge":1611.39,"discounted_cash":1127.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN PHOSPHATE INJ 600 MG/4ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457081500","type":"CDM"},{"code":"J0736","type":"HCPCS"},{"code":"67457081500","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457082312","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"67457082312","type":"NDC"}],"standard_charges":[{"gross_charge":296.23,"discounted_cash":207.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457082399","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"gross_charge":284.19,"discounted_cash":198.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457082415","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"67457082415","type":"NDC"}],"standard_charges":[{"gross_charge":355.47,"discounted_cash":248.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.5 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67457082499","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"67457082499","type":"NDC"}],"standard_charges":[{"gross_charge":351.48,"discounted_cash":246.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx67457085200","type":"CDM"},{"code":"67457085200","type":"NDC"}],"standard_charges":[{"gross_charge":108.81,"discounted_cash":76.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx67457085204","type":"CDM"},{"code":"67457085204","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457085500","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"67457085500","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ADENOSINE IV SOLN 6 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67457085502","type":"CDM"},{"code":"J0153","type":"HCPCS"},{"code":"67457085502","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457088700","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"67457088700","type":"NDC"}],"standard_charges":[{"gross_charge":429.9,"discounted_cash":300.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx67457088701","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"67457088701","type":"NDC"}],"standard_charges":[{"gross_charge":127.37,"discounted_cash":89.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES TAB 8.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67618030050","type":"CDM"},{"code":"67618030050","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67850002200","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"67850002200","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67850002210","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"67850002210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67850003100","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"67850003100","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAFCILLIN SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67850003110","type":"CDM"},{"code":"J2290","type":"HCPCS"},{"code":"67850003110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETHANOLAMINE OLEATE INJ 5%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx67871479006","type":"CDM"},{"code":"J1430","type":"HCPCS"},{"code":"67871479006","type":"NDC"}],"standard_charges":[{"gross_charge":1885.06,"discounted_cash":1319.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx67877012405","type":"CDM"},{"code":"67877012405","type":"NDC"}],"standard_charges":[{"gross_charge":76.84,"discounted_cash":53.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":400.0,"type":"GM"},"code_information":[{"code":"Rx67877012440","type":"CDM"},{"code":"67877012440","type":"NDC"}],"standard_charges":[{"gross_charge":159.93,"discounted_cash":111.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SILVER SULFADIAZINE CREAM 1%","drug_information":{"unit":50.0,"type":"GM"},"code_information":[{"code":"Rx67877012450","type":"CDM"},{"code":"67877012450","type":"NDC"}],"standard_charges":[{"gross_charge":76.84,"discounted_cash":53.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METFORMIN HCL TAB ER 24HR 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877015901","type":"CDM"},{"code":"67877015901","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877022301","type":"CDM"},{"code":"67877022301","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE CREAM 0.1%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx67877025115","type":"CDM"},{"code":"67877025115","type":"NDC"}],"standard_charges":[{"gross_charge":56.97,"discounted_cash":39.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN TAB 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877031901","type":"CDM"},{"code":"67877031901","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LINEZOLID TAB 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877041920","type":"CDM"},{"code":"67877041920","type":"NDC"}],"standard_charges":[{"gross_charge":13.46,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ARIPIPRAZOLE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877043103","type":"CDM"},{"code":"67877043103","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RABEPRAZOLE SODIUM EC TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877044330","type":"CDM"},{"code":"67877044330","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx67877054588","type":"CDM"},{"code":"67877054588","type":"NDC"}],"standard_charges":[{"gross_charge":11.23,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx67877054788","type":"CDM"},{"code":"67877054788","type":"NDC"}],"standard_charges":[{"gross_charge":12.85,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877056860","type":"CDM"},{"code":"67877056860","type":"NDC"}],"standard_charges":[{"gross_charge":14.04,"discounted_cash":9.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"COLCHICINE TAB 0.6 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx67877058901","type":"CDM"},{"code":"67877058901","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LUBRICANT GELS - GEL","drug_information":{"unit":57.0,"type":"GM"},"code_information":[{"code":"Rx67981008902","type":"CDM"},{"code":"67981008902","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68047025301","type":"CDM"},{"code":"68047025301","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084002701","type":"CDM"},{"code":"68084002701","type":"NDC"}],"standard_charges":[{"gross_charge":10.54,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WARFARIN SODIUM TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084002711","type":"CDM"},{"code":"68084002711","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PAROXETINE HCL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084004501","type":"CDM"},{"code":"68084004501","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084005201","type":"CDM"},{"code":"68084005201","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084006911","type":"CDM"},{"code":"68084006911","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084007001","type":"CDM"},{"code":"68084007001","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084007011","type":"CDM"},{"code":"68084007011","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009301","type":"CDM"},{"code":"68084009301","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009311","type":"CDM"},{"code":"68084009311","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB 25-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009411","type":"CDM"},{"code":"68084009411","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009701","type":"CDM"},{"code":"68084009701","type":"NDC"}],"standard_charges":[{"gross_charge":10.53,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009711","type":"CDM"},{"code":"68084009711","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009901","type":"CDM"},{"code":"68084009901","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATORVASTATIN CALCIUM TAB 40 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084009911","type":"CDM"},{"code":"68084009911","type":"NDC"}],"standard_charges":[{"gross_charge":10.89,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084010701","type":"CDM"},{"code":"68084010701","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACYCLOVIR CAP 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084010711","type":"CDM"},{"code":"68084010711","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084015501","type":"CDM"},{"code":"68084015501","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROMETHAZINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084015511","type":"CDM"},{"code":"68084015511","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084017401","type":"CDM"},{"code":"68084017401","type":"NDC"}],"standard_charges":[{"gross_charge":18.3,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DRONABINOL CAP 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084017411","type":"CDM"},{"code":"68084017411","type":"NDC"}],"standard_charges":[{"gross_charge":18.31,"discounted_cash":12.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084018401","type":"CDM"},{"code":"68084018401","type":"NDC"}],"standard_charges":[{"gross_charge":12.62,"discounted_cash":8.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084018411","type":"CDM"},{"code":"68084018411","type":"NDC"}],"standard_charges":[{"gross_charge":12.62,"discounted_cash":8.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084018511","type":"CDM"},{"code":"68084018511","type":"NDC"}],"standard_charges":[{"gross_charge":12.78,"discounted_cash":8.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084019611","type":"CDM"},{"code":"68084019611","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020201","type":"CDM"},{"code":"68084020201","type":"NDC"}],"standard_charges":[{"gross_charge":11.51,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRIMIDONE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020211","type":"CDM"},{"code":"68084020211","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MINOXIDIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020401","type":"CDM"},{"code":"68084020401","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MINOXIDIL TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084020411","type":"CDM"},{"code":"68084020411","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084021401","type":"CDM"},{"code":"68084021401","type":"NDC"}],"standard_charges":[{"gross_charge":10.82,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZONATATE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084021411","type":"CDM"},{"code":"68084021411","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084021501","type":"CDM"},{"code":"68084021501","type":"NDC"}],"standard_charges":[{"gross_charge":12.94,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084021511","type":"CDM"},{"code":"68084021511","type":"NDC"}],"standard_charges":[{"gross_charge":12.59,"discounted_cash":8.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084022901","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"68084022901","type":"NDC"}],"standard_charges":[{"gross_charge":11.31,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084022911","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"68084022911","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084023001","type":"CDM"},{"code":"68084023001","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084023011","type":"CDM"},{"code":"68084023011","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLINDAMYCIN HCL CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084024311","type":"CDM"},{"code":"68084024311","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084024801","type":"CDM"},{"code":"68084024801","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORATADINE TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084024811","type":"CDM"},{"code":"68084024811","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084026901","type":"CDM"},{"code":"68084026901","type":"NDC"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYCHLOROQUINE SULFATE TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084026911","type":"CDM"},{"code":"68084026911","type":"NDC"}],"standard_charges":[{"gross_charge":12.83,"discounted_cash":8.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084027201","type":"CDM"},{"code":"68084027201","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RISPERIDONE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084027211","type":"CDM"},{"code":"68084027211","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084027801","type":"CDM"},{"code":"68084027801","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":9.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028101","type":"CDM"},{"code":"68084028101","type":"NDC"}],"standard_charges":[{"gross_charge":11.37,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBIDOPA & LEVODOPA TAB ER 25-100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028111","type":"CDM"},{"code":"68084028111","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYUREA CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028401","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"68084028401","type":"NDC"}],"standard_charges":[{"gross_charge":11.83,"discounted_cash":8.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYUREA CAP 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028411","type":"CDM"},{"code":"J8999","type":"HCPCS"},{"code":"68084028411","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028801","type":"CDM"},{"code":"68084028801","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUDROCORTISONE ACETATE TAB 0.1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084028811","type":"CDM"},{"code":"68084028811","type":"NDC"}],"standard_charges":[{"gross_charge":11.27,"discounted_cash":7.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029201","type":"CDM"},{"code":"68084029201","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029901","type":"CDM"},{"code":"68084029901","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TAMSULOSIN HCL CAP 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084029911","type":"CDM"},{"code":"68084029911","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031301","type":"CDM"},{"code":"68084031301","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031311","type":"CDM"},{"code":"68084031311","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LAMOTRIGINE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031811","type":"CDM"},{"code":"68084031811","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031901","type":"CDM"},{"code":"68084031901","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LAMOTRIGINE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084031911","type":"CDM"},{"code":"68084031911","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032601","type":"CDM"},{"code":"68084032601","type":"NDC"}],"standard_charges":[{"gross_charge":11.18,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLIMEPIRIDE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032611","type":"CDM"},{"code":"68084032611","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032811","type":"CDM"},{"code":"68084032811","type":"NDC"}],"standard_charges":[{"gross_charge":13.62,"discounted_cash":9.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084032821","type":"CDM"},{"code":"68084032821","type":"NDC"}],"standard_charges":[{"gross_charge":15.17,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034201","type":"CDM"},{"code":"68084034201","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOPIRAMATE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034211","type":"CDM"},{"code":"68084034211","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034601","type":"CDM"},{"code":"68084034601","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034611","type":"CDM"},{"code":"68084034611","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034701","type":"CDM"},{"code":"68084034701","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOSARTAN POTASSIUM TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084034711","type":"CDM"},{"code":"68084034711","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084035411","type":"CDM"},{"code":"68084035411","type":"NDC"}],"standard_charges":[{"gross_charge":12.22,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIFAMPIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084035711","type":"CDM"},{"code":"68084035711","type":"NDC"}],"standard_charges":[{"gross_charge":11.89,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIFAMPIN CAP 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084035721","type":"CDM"},{"code":"68084035721","type":"NDC"}],"standard_charges":[{"gross_charge":11.89,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084037101","type":"CDM"},{"code":"68084037101","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMIODARONE HCL TAB 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084037111","type":"CDM"},{"code":"68084037111","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084037601","type":"CDM"},{"code":"68084037601","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYTOIN SODIUM EXTENDED CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084037611","type":"CDM"},{"code":"68084037611","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084038801","type":"CDM"},{"code":"68084038801","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZTROPINE MESYLATE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084038811","type":"CDM"},{"code":"68084038811","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084039611","type":"CDM"},{"code":"68084039611","type":"NDC"}],"standard_charges":[{"gross_charge":12.93,"discounted_cash":9.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084039665","type":"CDM"},{"code":"68084039665","type":"NDC"}],"standard_charges":[{"gross_charge":12.92,"discounted_cash":9.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084040001","type":"CDM"},{"code":"68084040001","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084042301","type":"CDM"},{"code":"68084042301","type":"NDC"}],"standard_charges":[{"gross_charge":11.76,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084042311","type":"CDM"},{"code":"68084042311","type":"NDC"}],"standard_charges":[{"gross_charge":11.76,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044601","type":"CDM"},{"code":"68084044601","type":"NDC"}],"standard_charges":[{"gross_charge":14.52,"discounted_cash":10.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084044611","type":"CDM"},{"code":"68084044611","type":"NDC"}],"standard_charges":[{"gross_charge":14.09,"discounted_cash":9.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TACROLIMUS CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084045001","type":"CDM"},{"code":"J7507","type":"HCPCS"},{"code":"68084045001","type":"NDC"}],"standard_charges":[{"gross_charge":12.35,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084047901","type":"CDM"},{"code":"68084047901","type":"NDC"}],"standard_charges":[{"gross_charge":12.05,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084047911","type":"CDM"},{"code":"68084047911","type":"NDC"}],"standard_charges":[{"gross_charge":12.11,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084048001","type":"CDM"},{"code":"68084048001","type":"NDC"}],"standard_charges":[{"gross_charge":12.99,"discounted_cash":9.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053611","type":"CDM"},{"code":"68084053611","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053901","type":"CDM"},{"code":"68084053901","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TORSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084053911","type":"CDM"},{"code":"68084053911","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084056111","type":"CDM"},{"code":"68084056111","type":"NDC"}],"standard_charges":[{"gross_charge":14.65,"discounted_cash":10.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBAMAZEPINE TAB ER 12HR 200 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084056121","type":"CDM"},{"code":"68084056121","type":"NDC"}],"standard_charges":[{"gross_charge":14.73,"discounted_cash":10.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN TAB ER 12HR 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084057201","type":"CDM"},{"code":"68084057201","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN TAB ER 12HR 600 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084057211","type":"CDM"},{"code":"68084057211","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059101","type":"CDM"},{"code":"68084059101","type":"NDC"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059111","type":"CDM"},{"code":"68084059111","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUCRALFATE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059311","type":"CDM"},{"code":"68084059311","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059411","type":"CDM"},{"code":"68084059411","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059701","type":"CDM"},{"code":"68084059701","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084059711","type":"CDM"},{"code":"68084059711","type":"NDC"}],"standard_charges":[{"gross_charge":11.45,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084063211","type":"CDM"},{"code":"68084063211","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064001","type":"CDM"},{"code":"68084064001","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LITHIUM CARBONATE TAB ER 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064011","type":"CDM"},{"code":"68084064011","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084064511","type":"CDM"},{"code":"68084064511","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084065901","type":"CDM"},{"code":"68084065901","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084065911","type":"CDM"},{"code":"68084065911","type":"NDC"}],"standard_charges":[{"gross_charge":11.53,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084067601","type":"CDM"},{"code":"68084067601","type":"NDC"}],"standard_charges":[{"gross_charge":11.08,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084067611","type":"CDM"},{"code":"68084067611","type":"NDC"}],"standard_charges":[{"gross_charge":11.08,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084068301","type":"CDM"},{"code":"68084068301","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084068311","type":"CDM"},{"code":"68084068311","type":"NDC"}],"standard_charges":[{"gross_charge":12.89,"discounted_cash":9.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069711","type":"CDM"},{"code":"68084069711","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069801","type":"CDM"},{"code":"68084069801","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084069811","type":"CDM"},{"code":"68084069811","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070825","type":"CDM"},{"code":"68084070825","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":7.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070895","type":"CDM"},{"code":"68084070895","type":"NDC"}],"standard_charges":[{"gross_charge":10.94,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070901","type":"CDM"},{"code":"68084070901","type":"NDC"}],"standard_charges":[{"gross_charge":11.01,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084070911","type":"CDM"},{"code":"68084070911","type":"NDC"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084072801","type":"CDM"},{"code":"68084072801","type":"NDC"}],"standard_charges":[{"gross_charge":12.58,"discounted_cash":8.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084072811","type":"CDM"},{"code":"68084072811","type":"NDC"}],"standard_charges":[{"gross_charge":11.93,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084073801","type":"CDM"},{"code":"68084073801","type":"NDC"}],"standard_charges":[{"gross_charge":12.05,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHADONE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084073811","type":"CDM"},{"code":"68084073811","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084075025","type":"CDM"},{"code":"68084075025","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":8.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 37.5-25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084075095","type":"CDM"},{"code":"68084075095","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084076211","type":"CDM"},{"code":"68084076211","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077401","type":"CDM"},{"code":"68084077401","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GABAPENTIN CAP 400 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077411","type":"CDM"},{"code":"68084077411","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077601","type":"CDM"},{"code":"68084077601","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084077611","type":"CDM"},{"code":"68084077611","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084080511","type":"CDM"},{"code":"68084080511","type":"NDC"}],"standard_charges":[{"gross_charge":13.92,"discounted_cash":9.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084080521","type":"CDM"},{"code":"68084080521","type":"NDC"}],"standard_charges":[{"gross_charge":15.65,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084080801","type":"CDM"},{"code":"68084080801","type":"NDC"}],"standard_charges":[{"gross_charge":11.76,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRAMADOL HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084080811","type":"CDM"},{"code":"68084080811","type":"NDC"}],"standard_charges":[{"gross_charge":11.68,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084081309","type":"CDM"},{"code":"68084081309","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084081311","type":"CDM"},{"code":"68084081311","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084082311","type":"CDM"},{"code":"68084082311","type":"NDC"}],"standard_charges":[{"gross_charge":13.59,"discounted_cash":9.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPHENIDATE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084082321","type":"CDM"},{"code":"68084082321","type":"NDC"}],"standard_charges":[{"gross_charge":14.59,"discounted_cash":10.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENOFIBRATE TAB 54 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084082795","type":"CDM"},{"code":"68084082795","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084401","type":"CDM"},{"code":"68084084401","type":"NDC"}],"standard_charges":[{"gross_charge":11.8,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084411","type":"CDM"},{"code":"68084084411","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084501","type":"CDM"},{"code":"68084084501","type":"NDC"}],"standard_charges":[{"gross_charge":10.89,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXCARBAZEPINE TAB 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084511","type":"CDM"},{"code":"68084084511","type":"NDC"}],"standard_charges":[{"gross_charge":10.67,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084701","type":"CDM"},{"code":"68084084701","type":"NDC"}],"standard_charges":[{"gross_charge":10.97,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROXYZINE PAMOATE CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084084711","type":"CDM"},{"code":"68084084711","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXAZOSIN MESYLATE TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084085195","type":"CDM"},{"code":"68084085195","type":"NDC"}],"standard_charges":[{"gross_charge":11.59,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084085501","type":"CDM"},{"code":"68084085501","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BACLOFEN TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084085511","type":"CDM"},{"code":"68084085511","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084087001","type":"CDM"},{"code":"68084087001","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084087011","type":"CDM"},{"code":"68084087011","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084087501","type":"CDM"},{"code":"68084087501","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084087511","type":"CDM"},{"code":"68084087511","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084089511","type":"CDM"},{"code":"68084089511","type":"NDC"}],"standard_charges":[{"gross_charge":12.41,"discounted_cash":8.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084090711","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"68084090711","type":"NDC"}],"standard_charges":[{"gross_charge":15.18,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MYCOPHENOLATE SODIUM TAB DR 180 MG (MYCOPHENOLIC ACID EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084090721","type":"CDM"},{"code":"J7518","type":"HCPCS"},{"code":"68084090721","type":"NDC"}],"standard_charges":[{"gross_charge":16.55,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SIROLIMUS TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084091525","type":"CDM"},{"code":"J7520","type":"HCPCS"},{"code":"68084091525","type":"NDC"}],"standard_charges":[{"gross_charge":26.43,"discounted_cash":18.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SIROLIMUS TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084091595","type":"CDM"},{"code":"J7520","type":"HCPCS"},{"code":"68084091595","type":"NDC"}],"standard_charges":[{"gross_charge":23.82,"discounted_cash":16.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084097501","type":"CDM"},{"code":"68084097501","type":"NDC"}],"standard_charges":[{"gross_charge":13.13,"discounted_cash":9.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084097511","type":"CDM"},{"code":"68084097511","type":"NDC"}],"standard_charges":[{"gross_charge":13.19,"discounted_cash":9.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084099601","type":"CDM"},{"code":"68084099601","type":"NDC"}],"standard_charges":[{"gross_charge":12.07,"discounted_cash":8.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRAZOSIN HCL CAP 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68084099611","type":"CDM"},{"code":"68084099611","type":"NDC"}],"standard_charges":[{"gross_charge":12.21,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094000559","type":"CDM"},{"code":"68094000559","type":"NDC"}],"standard_charges":[{"gross_charge":12.52,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094000561","type":"CDM"},{"code":"68094000561","type":"NDC"}],"standard_charges":[{"gross_charge":12.62,"discounted_cash":8.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094001859","type":"CDM"},{"code":"68094001859","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094001861","type":"CDM"},{"code":"68094001861","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094002259","type":"CDM"},{"code":"68094002259","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094002262","type":"CDM"},{"code":"68094002262","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx68094004501","type":"CDM"},{"code":"68094004501","type":"NDC"}],"standard_charges":[{"gross_charge":12.56,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094006359","type":"CDM"},{"code":"68094006359","type":"NDC"}],"standard_charges":[{"gross_charge":14.14,"discounted_cash":9.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENTOLAMINE MESYLATE FOR INJ 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094010120","type":"CDM"},{"code":"J2760","type":"HCPCS"},{"code":"68094010120","type":"NDC"}],"standard_charges":[{"gross_charge":1192.99,"discounted_cash":835.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASCORBIC ACID TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094011359","type":"CDM"},{"code":"68094011359","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094011659","type":"CDM"},{"code":"68094011659","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68094011661","type":"CDM"},{"code":"68094011661","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEGESTROL ACETATE SUSP 40 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094025059","type":"CDM"},{"code":"68094025059","type":"NDC"}],"standard_charges":[{"gross_charge":11.82,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":10.15,"type":"ML"},"code_information":[{"code":"Rx68094033059","type":"CDM"},{"code":"68094033059","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094049459","type":"CDM"},{"code":"68094049459","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx68094049461","type":"CDM"},{"code":"68094049461","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094058658","type":"CDM"},{"code":"68094058658","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094058759","type":"CDM"},{"code":"68094058759","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETAMINOPHEN SUSP 160 MG/5ML","drug_information":{"unit":10.15,"type":"ML"},"code_information":[{"code":"Rx68094058859","type":"CDM"},{"code":"68094058859","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094059959","type":"CDM"},{"code":"68094059959","type":"NDC"}],"standard_charges":[{"gross_charge":11.93,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN SUSP 100000 UNIT/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68094059962","type":"CDM"},{"code":"68094059962","type":"NDC"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094071659","type":"CDM"},{"code":"68094071659","type":"NDC"}],"standard_charges":[{"gross_charge":14.05,"discounted_cash":9.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx68094075401","type":"CDM"},{"code":"68094075401","type":"NDC"}],"standard_charges":[{"gross_charge":12.44,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094076459","type":"CDM"},{"code":"68094076459","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT)","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx68094076462","type":"CDM"},{"code":"68094076462","type":"NDC"}],"standard_charges":[{"gross_charge":17.13,"discounted_cash":11.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL CONC 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx68094080101","type":"CDM"},{"code":"68094080101","type":"NDC"}],"standard_charges":[{"gross_charge":17.76,"discounted_cash":12.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYCODONE HCL CONC 100 MG/5ML (20 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx68094080158","type":"CDM"},{"code":"68094080158","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx68180015001","type":"CDM"},{"code":"68180015001","type":"NDC"}],"standard_charges":[{"gross_charge":14.42,"discounted_cash":10.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETHACRYNIC ACID TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180015901","type":"CDM"},{"code":"68180015901","type":"NDC"}],"standard_charges":[{"gross_charge":13.46,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180016611","type":"CDM"},{"code":"68180016611","type":"NDC"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":22.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL CAP 125 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180016613","type":"CDM"},{"code":"68180016613","type":"NDC"}],"standard_charges":[{"gross_charge":13.59,"discounted_cash":9.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180029407","type":"CDM"},{"code":"68180029407","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180029506","type":"CDM"},{"code":"68180029506","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180029509","type":"CDM"},{"code":"68180029509","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180030220","type":"CDM"},{"code":"68180030220","type":"NDC"}],"standard_charges":[{"gross_charge":13.27,"discounted_cash":9.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFUROXIME AXETIL TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180030260","type":"CDM"},{"code":"68180030260","type":"NDC"}],"standard_charges":[{"gross_charge":13.01,"discounted_cash":9.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SERTRALINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180035209","type":"CDM"},{"code":"68180035209","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FENOFIBRATE TAB 160 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180036309","type":"CDM"},{"code":"68180036309","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEPHALEXIN FOR SUSP 250 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx68180044101","type":"CDM"},{"code":"68180044101","type":"NDC"}],"standard_charges":[{"gross_charge":11.51,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MELOXICAM TAB 15 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180050201","type":"CDM"},{"code":"68180050201","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180051301","type":"CDM"},{"code":"68180051301","type":"NDC"}],"standard_charges":[{"gross_charge":10.14,"discounted_cash":7.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180051501","type":"CDM"},{"code":"68180051501","type":"NDC"}],"standard_charges":[{"gross_charge":10.16,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180063301","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"68180063301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180063310","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"68180063310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180064401","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"68180064401","type":"NDC"}],"standard_charges":[{"gross_charge":168.69,"discounted_cash":118.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIFAMPIN CAP 300 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180065906","type":"CDM"},{"code":"68180065906","type":"NDC"}],"standard_charges":[{"gross_charge":11.38,"discounted_cash":7.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180067511","type":"CDM"},{"code":"68180067511","type":"NDC"}],"standard_charges":[{"gross_charge":12.56,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180067711","type":"CDM"},{"code":"68180067711","type":"NDC"}],"standard_charges":[{"gross_charge":12.56,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"Rx68180067801","type":"CDM"},{"code":"68180067801","type":"NDC"}],"standard_charges":[{"gross_charge":13.69,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIVAROXABAN TAB 2.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180070906","type":"CDM"},{"code":"68180070906","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx68180072205","type":"CDM"},{"code":"68180072205","type":"NDC"}],"standard_charges":[{"gross_charge":15.34,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx68180072210","type":"CDM"},{"code":"68180072210","type":"NDC"}],"standard_charges":[{"gross_charge":12.29,"discounted_cash":8.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFDINIR FOR SUSP 125 MG/5ML","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"Rx68180072220","type":"CDM"},{"code":"68180072220","type":"NDC"}],"standard_charges":[{"gross_charge":13.17,"discounted_cash":9.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVONORGESTREL TAB 1.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180085211","type":"CDM"},{"code":"68180085211","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":7.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":8.5,"type":"GM"},"code_information":[{"code":"Rx68180096301","type":"CDM"},{"code":"68180096301","type":"NDC"}],"standard_charges":[{"gross_charge":109.29,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVOTHYROXINE SODIUM TAB 50 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180096601","type":"CDM"},{"code":"68180096601","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LISINOPRIL TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68180098101","type":"CDM"},{"code":"68180098101","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68220011310","type":"CDM"},{"code":"68220011310","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZATHIOPRINE TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382000301","type":"CDM"},{"code":"J7500","type":"HCPCS"},{"code":"68382000301","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRAVASTATIN SODIUM TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382007116","type":"CDM"},{"code":"68382007116","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIVALPROEX SODIUM CAP DELAYED RELEASE SPRINKLE 125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382010601","type":"CDM"},{"code":"68382010601","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RISPERIDONE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382011214","type":"CDM"},{"code":"68382011214","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382019716","type":"CDM"},{"code":"68382019716","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382030901","type":"CDM"},{"code":"68382030901","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":7.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":60.0,"type":"GM"},"code_information":[{"code":"Rx68382037003","type":"CDM"},{"code":"68382037003","type":"NDC"}],"standard_charges":[{"gross_charge":108.55,"discounted_cash":75.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx68382044405","type":"CDM"},{"code":"68382044405","type":"NDC"}],"standard_charges":[{"gross_charge":14.35,"discounted_cash":10.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLESTYRAMINE LIGHT POWDER PACKETS 4 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382052960","type":"CDM"},{"code":"68382052960","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SPIRONOLACTONE TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382066001","type":"CDM"},{"code":"68382066001","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NATEGLINIDE TAB 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382072216","type":"CDM"},{"code":"68382072216","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382079801","type":"CDM"},{"code":"68382079801","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DOXYCYCLINE HYCLATE FOR INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68382091001","type":"CDM"},{"code":"J1271","type":"HCPCS"},{"code":"68382091001","type":"NDC"}],"standard_charges":[{"gross_charge":341.32,"discounted_cash":238.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462010230","type":"CDM"},{"code":"68462010230","type":"NDC"}],"standard_charges":[{"gross_charge":10.87,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462015713","type":"CDM"},{"code":"68462015713","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462015740","type":"CDM"},{"code":"68462015740","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NAPROXEN TAB 250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462018801","type":"CDM"},{"code":"68462018801","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FELODIPINE TAB ER 24HR 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462023401","type":"CDM"},{"code":"68462023401","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 120 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462029201","type":"CDM"},{"code":"68462029201","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462029301","type":"CDM"},{"code":"68462029301","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx68462029817","type":"CDM"},{"code":"68462029817","type":"NDC"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":43.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NABUMETONE TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462035801","type":"CDM"},{"code":"68462035801","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INDOMETHACIN CAP 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462040601","type":"CDM"},{"code":"68462040601","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE INJ 0.25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462047040","type":"CDM"},{"code":"J1939","type":"HCPCS"},{"code":"68462047040","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.25 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462047830","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"68462047830","type":"NDC"}],"standard_charges":[{"gross_charge":292.94,"discounted_cash":205.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062210","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx68462062264","type":"CDM"},{"code":"Q2009","type":"HCPCS"},{"code":"68462062264","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462063925","type":"CDM"},{"code":"68462063925","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68462063945","type":"CDM"},{"code":"68462063945","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx68462075801","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"68462075801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx68462089601","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"68462089601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OCTREOTIDE ACETATE INJ 100 MCG/ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx68462089610","type":"CDM"},{"code":"J2354","type":"HCPCS"},{"code":"68462089610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx68516521600","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"68516521600","type":"NDC"}],"standard_charges":[{"gross_charge":501.64,"discounted_cash":351.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx68516521601","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"68516521601","type":"NDC"}],"standard_charges":[{"gross_charge":501.64,"discounted_cash":351.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx68516521602","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"68516521602","type":"NDC"}],"standard_charges":[{"gross_charge":502.44,"discounted_cash":351.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx68516521608","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"68516521608","type":"NDC"}],"standard_charges":[{"gross_charge":633.61,"discounted_cash":443.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM CHLORIDE TAB DR 64 MG (ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68585000575","type":"CDM"},{"code":"68585000575","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM OXIDE TAB 400 MG (240 MG ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68585000698","type":"CDM"},{"code":"68585000698","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZINC SULFATE CAP 220 MG (50 MG ELEMENTAL ZN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68585000801","type":"CDM"},{"code":"68585000801","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETHACRYNIC ACID TAB 25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68682001110","type":"CDM"},{"code":"68682001110","type":"NDC"}],"standard_charges":[{"gross_charge":14.03,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ETHACRYNATE SODIUM FOR INJ 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68682001227","type":"CDM"},{"code":"J1807","type":"HCPCS"},{"code":"68682001227","type":"NDC"}],"standard_charges":[{"gross_charge":2508.09,"discounted_cash":1755.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM RECTAL GEL DELIVERY SYSTEM 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68682065220","type":"CDM"},{"code":"68682065220","type":"NDC"}],"standard_charges":[{"gross_charge":531.69,"discounted_cash":372.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRYPAN BLUE INTRAOCULAR SOLN PREF SYR 0.06%","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx68803061210","type":"CDM"},{"code":"68803061210","type":"NDC"}],"standard_charges":[{"gross_charge":196.07,"discounted_cash":137.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROTHROMBIN COMPLEX CONCENTRATE HUMAN-LANS FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68982026101","type":"CDM"},{"code":"J7165","type":"HCPCS"},{"code":"68982026101","type":"NDC"}],"standard_charges":[{"gross_charge":3190.56,"discounted_cash":2233.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROTHROMBIN COMPLEX CONCENTRATE HUMAN-LANS FOR INJ 500 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx68982026181","type":"CDM"},{"code":"J7165","type":"HCPCS"},{"code":"68982026181","type":"NDC"}],"standard_charges":[{"gross_charge":3468.0,"discounted_cash":2427.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx69097000367","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"69097000367","type":"NDC"}],"standard_charges":[{"gross_charge":178.4,"discounted_cash":124.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)","drug_information":{"unit":6.7,"type":"GM"},"code_information":[{"code":"Rx69097014260","type":"CDM"},{"code":"69097014260","type":"NDC"}],"standard_charges":[{"gross_charge":91.47,"discounted_cash":64.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALACYCLOVIR HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097015302","type":"CDM"},{"code":"69097015302","type":"NDC"}],"standard_charges":[{"gross_charge":11.51,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MELOXICAM TAB 7.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097015807","type":"CDM"},{"code":"69097015807","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69097017348","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"69097017348","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx69097052444","type":"CDM"},{"code":"69097052444","type":"NDC"}],"standard_charges":[{"gross_charge":13.8,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx69097070831","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"69097070831","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE INJ 10 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx69097070896","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"69097070896","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx69097072044","type":"CDM"},{"code":"69097072044","type":"NDC"}],"standard_charges":[{"gross_charge":4.6,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69097084034","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"69097084034","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69097084053","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"69097084053","type":"NDC"}],"standard_charges":[{"gross_charge":11.23,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69097084087","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"69097084087","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYCLOBENZAPRINE HCL TAB 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097084607","type":"CDM"},{"code":"69097084607","type":"NDC"}],"standard_charges":[{"gross_charge":10.16,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69097099902","type":"CDM"},{"code":"69097099902","type":"NDC"}],"standard_charges":[{"gross_charge":20.77,"discounted_cash":14.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE TAB 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238105103","type":"CDM"},{"code":"69238105103","type":"NDC"}],"standard_charges":[{"gross_charge":79.28,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238131109","type":"CDM"},{"code":"69238131109","type":"NDC"}],"standard_charges":[{"gross_charge":11.69,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUMETANIDE TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238149001","type":"CDM"},{"code":"69238149001","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238161701","type":"CDM"},{"code":"69238161701","type":"NDC"}],"standard_charges":[{"gross_charge":14.98,"discounted_cash":10.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69238161703","type":"CDM"},{"code":"69238161703","type":"NDC"}],"standard_charges":[{"gross_charge":12.72,"discounted_cash":8.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLURBIPROFEN SODIUM OPHTH SOLN 0.03%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx69292072225","type":"CDM"},{"code":"69292072225","type":"NDC"}],"standard_charges":[{"gross_charge":145.53,"discounted_cash":101.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315011601","type":"CDM"},{"code":"69315011601","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCHLOROTHIAZIDE TAB 12.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315015501","type":"CDM"},{"code":"69315015501","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":15.0,"type":"GM"},"code_information":[{"code":"Rx69315030615","type":"CDM"},{"code":"69315030615","type":"NDC"}],"standard_charges":[{"gross_charge":64.74,"discounted_cash":45.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NYSTATIN TOPICAL POWDER 100000 UNIT/GM","drug_information":{"unit":30.0,"type":"GM"},"code_information":[{"code":"Rx69315030630","type":"CDM"},{"code":"69315030630","type":"NDC"}],"standard_charges":[{"gross_charge":75.54,"discounted_cash":52.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE PERIANAL CREAM 2.5%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx69315031228","type":"CDM"},{"code":"69315031228","type":"NDC"}],"standard_charges":[{"gross_charge":71.53,"discounted_cash":50.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315090401","type":"CDM"},{"code":"69315090401","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LORAZEPAM TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315090501","type":"CDM"},{"code":"69315090501","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENOXYLATE W/ ATROPINE TAB 2.5-0.025 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69315091001","type":"CDM"},{"code":"69315091001","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69339013602","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"69339013602","type":"NDC"}],"standard_charges":[{"gross_charge":125.66,"discounted_cash":87.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69339013603","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"69339013603","type":"NDC"}],"standard_charges":[{"gross_charge":125.66,"discounted_cash":87.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx69339013634","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"69339013634","type":"NDC"}],"standard_charges":[{"gross_charge":111.77,"discounted_cash":78.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx69339013693","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"69339013693","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIAZEPAM INJ 5 MG/ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx69339013697","type":"CDM"},{"code":"J3360","type":"HCPCS"},{"code":"69339013697","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69339014905","type":"CDM"},{"code":"69339014905","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx69339014919","type":"CDM"},{"code":"69339014919","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx69374030010","type":"CDM"},{"code":"J0330","type":"HCPCS"},{"code":"69374030010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE SOLN PREF SYR 5 MG/5ML (1 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx69374090205","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"69374090205","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx69374091450","type":"CDM"},{"code":"69374091450","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MAGNESIUM OXIDE TAB 400 MG (240 MG ELEMENTAL MG)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69543021712","type":"CDM"},{"code":"69543021712","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL NASAL SPRAY 4 MG/0.1ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69547062700","type":"CDM"},{"code":"69547062700","type":"NDC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":14.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx69784000206","type":"CDM"},{"code":"J1450","type":"HCPCS"},{"code":"69784000206","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx69784018001","type":"CDM"},{"code":"69784018001","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DESMOPRESSIN ACETATE PRESERVATIVE FREE (PF) INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx69918089910","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"69918089910","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DESMOPRESSIN ACETATE INJ 4 MCG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx69918090110","type":"CDM"},{"code":"J2597","type":"HCPCS"},{"code":"69918090110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE TAB 20 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000004901","type":"CDM"},{"code":"70000004901","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000017801","type":"CDM"},{"code":"70000017801","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROMETHORPHAN POLISTIREX EXTENDED RELEASE SUSP 30 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx70000019501","type":"CDM"},{"code":"70000019501","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000021802","type":"CDM"},{"code":"70000021802","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70000029901","type":"CDM"},{"code":"70000029901","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE CREAM 2-0.1%","drug_information":{"unit":28.0,"type":"GM"},"code_information":[{"code":"Rx70000038801","type":"CDM"},{"code":"70000038801","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LOPERAMIDE HCL SOLN 1 MG/7.5ML","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"Rx70000041801","type":"CDM"},{"code":"70000041801","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOL LIQUID 1.4%","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"Rx70000045801","type":"CDM"},{"code":"70000045801","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROCORTISONE CREAM 1%","drug_information":{"unit":28.4,"type":"GM"},"code_information":[{"code":"Rx70000048501","type":"CDM"},{"code":"70000048501","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARBAMIDE PEROXIDE 6.5% OTIC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx70000049001","type":"CDM"},{"code":"70000049001","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NICOTINE TD PATCH 24HR 7 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000051002","type":"CDM"},{"code":"70000051002","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx70000051301","type":"CDM"},{"code":"70000051301","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM TAB 8.6-50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000052601","type":"CDM"},{"code":"70000052601","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DICLOFENAC SODIUM GEL 1% (1.16% DIETHYLAMINE EQUIV)","drug_information":{"unit":100.0,"type":"GM"},"code_information":[{"code":"Rx70000055502","type":"CDM"},{"code":"70000055502","type":"NDC"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":5.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BISACODYL SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000057301","type":"CDM"},{"code":"70000057301","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MENTHOL LOZENGE 5.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70000064001","type":"CDM"},{"code":"70000064001","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METFORMIN HCL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010006301","type":"CDM"},{"code":"70010006301","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHOCARBAMOL TAB 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010075401","type":"CDM"},{"code":"70010075401","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHOCARBAMOL TAB 750 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70010077001","type":"CDM"},{"code":"70010077001","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70069001101","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"70069001101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70069001125","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"70069001125","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MALEATE OPHTH SOLN 2-0.5%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx70069005101","type":"CDM"},{"code":"70069005101","type":"NDC"}],"standard_charges":[{"gross_charge":76.89,"discounted_cash":53.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70069007101","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70069007101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70069007110","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70069007110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TROPICAMIDE OPHTH SOLN 1%","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"Rx70069012101","type":"CDM"},{"code":"70069012101","type":"NDC"}],"standard_charges":[{"gross_charge":72.91,"discounted_cash":51.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TOBRAMYCIN OPHTH SOLN 0.3%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069013101","type":"CDM"},{"code":"70069013101","type":"NDC"}],"standard_charges":[{"gross_charge":63.68,"discounted_cash":44.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BRIMONIDINE TARTRATE OPHTH SOLN 0.2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70069023101","type":"CDM"},{"code":"70069023101","type":"NDC"}],"standard_charges":[{"gross_charge":58.64,"discounted_cash":41.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069027101","type":"CDM"},{"code":"70069027101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL IV SOLN 2.5 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70069027105","type":"CDM"},{"code":"70069027105","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70069037101","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"70069037101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LATANOPROST OPHTH SOLN 0.005%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx70069042101","type":"CDM"},{"code":"70069042101","type":"NDC"}],"standard_charges":[{"gross_charge":62.61,"discounted_cash":43.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE INJ 8 MG/20ML (0.4 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70069048101","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"70069048101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70069081901","type":"CDM"},{"code":"70069081901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx70092106807","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70092106807","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70092138036","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"70092138036","type":"NDC"}],"standard_charges":[{"gross_charge":129.61,"discounted_cash":90.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL IV SOLN 1 MG/ML,HYDROMORPHONE HCL IV SOLN PREF SYR 50 MG/50ML,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 100 MG/100ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx70092168748","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"70092168748","type":"NDC"}],"standard_charges":[{"gross_charge":242.55,"discounted_cash":169.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70095002501","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70095002501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70095002502","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70095002502","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121104901","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"70121104901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70121104902","type":"CDM"},{"code":"J3301","type":"HCPCS"},{"code":"70121104902","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70121118901","type":"CDM"},{"code":"70121118901","type":"NDC"}],"standard_charges":[{"gross_charge":273.63,"discounted_cash":191.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70121138901","type":"CDM"},{"code":"70121138901","type":"NDC"}],"standard_charges":[{"gross_charge":475.24,"discounted_cash":332.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 0.9% IV SOLN 400 MCG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70121138907","type":"CDM"},{"code":"70121138907","type":"NDC"}],"standard_charges":[{"gross_charge":232.99,"discounted_cash":163.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70121145401","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"70121145401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx70121155201","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"70121155201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM-AYOW SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx70121157001","type":"CDM"},{"code":"Q5125","type":"HCPCS"},{"code":"70121157001","type":"NDC"}],"standard_charges":[{"gross_charge":1937.82,"discounted_cash":1356.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FILGRASTIM-AYOW SOLN PREFILLED SYRINGE 480 MCG/0.8ML","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"Rx70121157007","type":"CDM"},{"code":"Q5125","type":"HCPCS"},{"code":"70121157007","type":"NDC"}],"standard_charges":[{"gross_charge":1937.78,"discounted_cash":1356.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx70121157401","type":"CDM"},{"code":"J1010","type":"HCPCS"},{"code":"70121157401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":0.006,"type":"ML"},"code_information":[{"code":"Rx70121157801","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70121157801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70121157801","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70121157801","type":"NDC"}],"standard_charges":[{"gross_charge":114.95,"discounted_cash":80.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70121157807","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70121157807","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70121160501","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70121160501","type":"NDC"}],"standard_charges":[{"gross_charge":237.41,"discounted_cash":166.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ISOPROTERENOL HCL INJ 0.2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70121160507","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70121160507","type":"NDC"}],"standard_charges":[{"gross_charge":234.77,"discounted_cash":164.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL IV SOLN 1 MG/ML,HYDROMORPHONE HCL IV SOLN PREF SYR 50 MG/50ML,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 100 MG/100ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx70214301101","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"70214301101","type":"NDC"}],"standard_charges":[{"gross_charge":252.28,"discounted_cash":176.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"Rx70214503001","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"70214503001","type":"NDC"}],"standard_charges":[{"gross_charge":146.58,"discounted_cash":102.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx70377011311","type":"CDM"},{"code":"70377011311","type":"NDC"}],"standard_charges":[{"gross_charge":10.76,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 24HR 150 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436001006","type":"CDM"},{"code":"70436001006","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":8.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436001982","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70436001982","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436002082","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436002182","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BUPROPION HCL TAB ER 12HR 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70436005801","type":"CDM"},{"code":"70436005801","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INFLUENZA VIRUS VAC TISS-CULT SUBUNIT SUSP PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461065503","type":"CDM"},{"code":"90661","type":"HCPCS"},{"code":"70461065503","type":"NDC"}],"standard_charges":[{"gross_charge":404.81,"discounted_cash":283.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INFLUENZA VIRUS VAC TISS-CULT SUBUNIT SUSP PREF SYR 0.5 ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx70461065504","type":"CDM"},{"code":"90661","type":"HCPCS"},{"code":"70461065504","type":"NDC"}],"standard_charges":[{"gross_charge":404.81,"discounted_cash":283.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70512079005","type":"CDM"},{"code":"70512079005","type":"NDC"}],"standard_charges":[{"gross_charge":66.56,"discounted_cash":46.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594007501","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"70594007501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEROPENEM IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594007502","type":"CDM"},{"code":"J2185","type":"HCPCS"},{"code":"70594007502","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594007901","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"70594007901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594007902","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"70594007902","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594009601","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"70594009601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CEFTRIAXONE SODIUM FOR INJ 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594009602","type":"CDM"},{"code":"J0696","type":"HCPCS"},{"code":"70594009602","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx70594011101","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"70594011101","type":"NDC"}],"standard_charges":[{"gross_charge":389.7,"discounted_cash":272.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ACETYLCYSTEINE INJ 200 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx70594011102","type":"CDM"},{"code":"J0132","type":"HCPCS"},{"code":"70594011102","type":"NDC"}],"standard_charges":[{"gross_charge":335.33,"discounted_cash":234.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594012201","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70594012201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70594012202","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70594012202","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MEDROXYPROGESTERONE ACETATE IM SUSP 150 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70700031527","type":"CDM"},{"code":"J1050","type":"HCPCS"},{"code":"70700031527","type":"NDC"}],"standard_charges":[{"gross_charge":127.35,"discounted_cash":89.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710100802","type":"CDM"},{"code":"70710100802","type":"NDC"}],"standard_charges":[{"gross_charge":13.16,"discounted_cash":9.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70710101002","type":"CDM"},{"code":"70710101002","type":"NDC"}],"standard_charges":[{"gross_charge":13.41,"discounted_cash":9.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70710135901","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"70710135901","type":"NDC"}],"standard_charges":[{"gross_charge":233.45,"discounted_cash":163.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70710135906","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"70710135906","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN FOR SUSP 200 MG/5ML","drug_information":{"unit":6.25,"type":"ML"},"code_information":[{"code":"Rx70710145902","type":"CDM"},{"code":"70710145902","type":"NDC"}],"standard_charges":[{"gross_charge":16.84,"discounted_cash":11.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx70710147801","type":"CDM"},{"code":"J1451","type":"HCPCS"},{"code":"70710147801","type":"NDC"}],"standard_charges":[{"gross_charge":2246.28,"discounted_cash":1572.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70710188601","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"70710188601","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx70710188601","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"70710188601","type":"NDC"}],"standard_charges":[{"gross_charge":317.24,"discounted_cash":222.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx70710188606","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"70710188606","type":"NDC"}],"standard_charges":[{"gross_charge":152.44,"discounted_cash":106.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LACOSAMIDE IV INJ 200 MG/20ML (10 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70710188606","type":"CDM"},{"code":"C9254","type":"HCPCS"},{"code":"70710188606","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NITROGLYCERIN SL TAB 0.4 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70756001405","type":"CDM"},{"code":"70756001405","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":7.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70756061125","type":"CDM"},{"code":"70756061125","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx70756061182","type":"CDM"},{"code":"70756061182","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70756062210","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70756062210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70756062285","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"70756062285","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL OPHTH SOLN 2.5%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70756062925","type":"CDM"},{"code":"70756062925","type":"NDC"}],"standard_charges":[{"gross_charge":87.44,"discounted_cash":61.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064525","type":"CDM"},{"code":"70756064525","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70756064586","type":"CDM"},{"code":"70756064586","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE OPHTH SOLN 1%","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70756065125","type":"CDM"},{"code":"70756065125","type":"NDC"}],"standard_charges":[{"gross_charge":146.65,"discounted_cash":102.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL INJ 0.4 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx70756065882","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"70756065882","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860010010","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70860010010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AZITHROMYCIN IV FOR SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860010041","type":"CDM"},{"code":"J0456","type":"HCPCS"},{"code":"70860010041","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70860010520","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"70860010520","type":"NDC"}],"standard_charges":[{"gross_charge":109.31,"discounted_cash":76.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx70860030242","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"70860030242","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70860060341","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"70860060341","type":"NDC"}],"standard_charges":[{"gross_charge":248.42,"discounted_cash":173.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM IN SODIUM CHLORIDE IV SOLN 1000 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx70860060382","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"70860060382","type":"NDC"}],"standard_charges":[{"gross_charge":163.55,"discounted_cash":114.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx70860070101","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"70860070101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70860077602","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"70860077602","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70860077802","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"70860077802","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx70860077841","type":"CDM"},{"code":"J0780","type":"HCPCS"},{"code":"70860077841","type":"NDC"}],"standard_charges":[{"gross_charge":101.25,"discounted_cash":70.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860078405","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860078405","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VALPROATE SODIUM INJ 100 MG/ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx70860078441","type":"CDM"},{"code":"J3490","type":"HCPCS"},{"code":"70860078441","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIHEXYPHENIDYL HCL TAB 2 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954021210","type":"CDM"},{"code":"70954021210","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FAMOTIDINE FOR SUSP 40 MG/5ML","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"Rx70954031610","type":"CDM"},{"code":"70954031610","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MISOPROSTOL TAB 200 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954044420","type":"CDM"},{"code":"70954044420","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ESTRADIOL TAB 0.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx70954056410","type":"CDM"},{"code":"70954056410","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE EXTERNAL SOLN,LIDOCAINE-EPINEPHRINE-TETRACAINE EXTERNAL SOLN 4-0.05-0.5%,LIDOCAINE-RACEPINEPHRINE-TETRACAINE EXTERNAL SOL 4-0.05-0.5%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx71266627603","type":"CDM"},{"code":"71266627603","type":"NDC"}],"standard_charges":[{"gross_charge":214.65,"discounted_cash":150.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288000520","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288000520","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288000630","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288000630","type":"NDC"}],"standard_charges":[{"gross_charge":129.88,"discounted_cash":90.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288001615","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"gross_charge":226.25,"discounted_cash":158.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DAPTOMYCIN FOR IV SOLN 500 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288001695","type":"CDM"},{"code":"J0878","type":"HCPCS"},{"code":"71288001695","type":"NDC"}],"standard_charges":[{"gross_charge":233.25,"discounted_cash":163.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288002320","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"71288002320","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288002321","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288003120","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288003120","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288003121","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288003121","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288003220","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288003220","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288003221","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"71288003221","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288020304","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"71288020304","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"FUROSEMIDE INJ 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71288020305","type":"CDM"},{"code":"J1938","type":"HCPCS"},{"code":"71288020305","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYANOCOBALAMIN INJ 1000 MCG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx71288030391","type":"CDM"},{"code":"J3420","type":"HCPCS"},{"code":"71288030391","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040210","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288040211","type":"CDM"},{"code":"J1644","type":"HCPCS"},{"code":"71288040211","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx71288041088","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041088","type":"NDC"}],"standard_charges":[{"gross_charge":102.78,"discounted_cash":71.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 100 MG/ML","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"Rx71288041089","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041089","type":"NDC"}],"standard_charges":[{"gross_charge":101.72,"discounted_cash":71.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx71288041182","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041182","type":"NDC"}],"standard_charges":[{"gross_charge":148.67,"discounted_cash":104.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 150 MG/ML","drug_information":{"unit":0.866666666666667,"type":"ML"},"code_information":[{"code":"Rx71288041183","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288041183","type":"NDC"}],"standard_charges":[{"gross_charge":288.34,"discounted_cash":201.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML)","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx71288041351","type":"CDM"},{"code":"J1327","type":"HCPCS"},{"code":"71288041351","type":"NDC"}],"standard_charges":[{"gross_charge":709.14,"discounted_cash":496.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288041401","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"71288041401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GLYCOPYRROLATE INJ 0.2 MG/ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288041403","type":"CDM"},{"code":"J1596","type":"HCPCS"},{"code":"71288041403","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx71288043280","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043280","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 30 MG/0.3ML","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"Rx71288043281","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043281","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx71288043382","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043382","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx71288043383","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043383","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288043484","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043484","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71288043485","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71288043485","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288060010","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"71288060010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71288060011","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"71288060011","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 20 MG/2ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 75 MG/7.5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288070005","type":"CDM"},{"code":"71288070005","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx71288070006","type":"CDM"},{"code":"71288070006","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx71288080651","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"71288080651","type":"NDC"}],"standard_charges":[{"gross_charge":418.15,"discounted_cash":292.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx71399002404","type":"CDM"},{"code":"71399002404","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VITAMINS A & D OINT","drug_information":{"unit":113.0,"type":"GM"},"code_information":[{"code":"Rx71399012204","type":"CDM"},{"code":"71399012204","type":"NDC"}],"standard_charges":[{"gross_charge":3.61,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE-NACL PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN PREF SYR 1 MG/10ML (100 MCG/ML),PHENYLEPHRINE HCL IV SOLN 1 MG/10ML (100 MCG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx71449000115","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71449000115","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL IV SOLN 1 MG/ML,HYDROMORPHONE HCL IV SOLN PREF SYR 50 MG/50ML,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 50 MG/50ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% INJ 100 MG/100ML,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 100 MG/100ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx71449001832","type":"CDM"},{"code":"J7999","type":"HCPCS"},{"code":"71449001832","type":"NDC"}],"standard_charges":[{"gross_charge":275.88,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 40 MG/0.4ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx71839011010","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71839011010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 60 MG/0.6ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx71839011110","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71839011110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 80 MG/0.8ML","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"Rx71839011210","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71839011210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ENOXAPARIN SODIUM INJ SOLN PREF SYR 120 MG/0.8ML","drug_information":{"unit":0.733333333333333,"type":"ML"},"code_information":[{"code":"Rx71839011510","type":"CDM"},{"code":"J1650","type":"HCPCS"},{"code":"71839011510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE INJ KIT 1 MG/ML (1:1000)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx71923010020","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"71923010020","type":"NDC"}],"standard_charges":[{"gross_charge":944.46,"discounted_cash":661.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.75 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72078006550","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"72078006550","type":"NDC"}],"standard_charges":[{"gross_charge":540.32,"discounted_cash":378.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1.75 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72078006599","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"72078006599","type":"NDC"}],"standard_charges":[{"gross_charge":540.39,"discounted_cash":378.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 2 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72078006650","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"72078006650","type":"NDC"}],"standard_charges":[{"gross_charge":617.54,"discounted_cash":432.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 2 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72078006699","type":"CDM"},{"code":"J3374","type":"HCPCS"},{"code":"72078006699","type":"NDC"}],"standard_charges":[{"gross_charge":617.41,"discounted_cash":432.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SKIN PROTECTANTS MISC - CREAM","drug_information":{"unit":454.0,"type":"GM"},"code_information":[{"code":"Rx72140000021","type":"CDM"},{"code":"72140000021","type":"NDC"}],"standard_charges":[{"gross_charge":12.71,"discounted_cash":8.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PREGABALIN CAP 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205001290","type":"CDM"},{"code":"72205001290","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205004411","type":"CDM"},{"code":"72205004411","type":"NDC"}],"standard_charges":[{"gross_charge":13.33,"discounted_cash":9.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ROFLUMILAST TAB 500 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72205020030","type":"CDM"},{"code":"72205020030","type":"NDC"}],"standard_charges":[{"gross_charge":11.07,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"RIVASTIGMINE TARTRATE CAP 1.5 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72241001103","type":"CDM"},{"code":"72241001103","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72266010201","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"72266010201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72266011801","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72266011801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72266011825","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72266011825","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72266012301","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"72266012301","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72266012325","type":"CDM"},{"code":"J2405","type":"HCPCS"},{"code":"72266012325","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZOLEDRONIC ACID IV SOLN 5 MG/100ML","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"Rx72266015201","type":"CDM"},{"code":"J3489","type":"HCPCS"},{"code":"72266015201","type":"NDC"}],"standard_charges":[{"gross_charge":985.64,"discounted_cash":689.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx72266015801","type":"CDM"},{"code":"72266015801","type":"NDC"}],"standard_charges":[{"gross_charge":81.56,"discounted_cash":57.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72485010101","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"72485010101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIPHENHYDRAMINE HCL INJ 50 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx72485010125","type":"CDM"},{"code":"J1200","type":"HCPCS"},{"code":"72485010125","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72485010601","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"72485010601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx72485010610","type":"CDM"},{"code":"J1953","type":"HCPCS"},{"code":"72485010610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485040301","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"72485040301","type":"NDC"}],"standard_charges":[{"gross_charge":116.07,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485040310","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"72485040310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485040401","type":"CDM"},{"code":"J2543","type":"HCPCS"},{"code":"72485040401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485041601","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"72485041601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485041610","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"72485041610","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485041701","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"72485041701","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485041710","type":"CDM"},{"code":"J0295","type":"HCPCS"},{"code":"72485041710","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485042201","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"72485042201","type":"NDC"}],"standard_charges":[{"gross_charge":103.65,"discounted_cash":72.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"AMPICILLIN SODIUM FOR INJ 2 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72485042210","type":"CDM"},{"code":"J0290","type":"HCPCS"},{"code":"72485042210","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ERYTHROMYCIN OPHTH OINT 5 MG/GM","drug_information":{"unit":3.5,"type":"GM"},"code_information":[{"code":"Rx72485067035","type":"CDM"},{"code":"72485067035","type":"NDC"}],"standard_charges":[{"gross_charge":79.66,"discounted_cash":55.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572037001","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"72572037001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72572037025","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"72572037025","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572043001","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"72572043001","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 3 MG/3ML,MIDAZOLAM INJ SOLN PREFILLED SYRINGE 5 MG/5ML","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx72572043025","type":"CDM"},{"code":"J2250","type":"HCPCS"},{"code":"72572043025","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72572055001","type":"CDM"},{"code":"J2470","type":"HCPCS"},{"code":"72572055001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"Rx72572074001","type":"CDM"},{"code":"72572074001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 15 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx72611071901","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72611071901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72611072201","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72611072201","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"KETOROLAC TROMETHAMINE INJ 30 MG/ML","drug_information":{"unit":0.333333333333333,"type":"ML"},"code_information":[{"code":"Rx72611072225","type":"CDM"},{"code":"J1885","type":"HCPCS"},{"code":"72611072225","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 10 MG/2ML (5 MG/ML)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"Rx72611073401","type":"CDM"},{"code":"J1920","type":"HCPCS"},{"code":"72611073401","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx72611074001","type":"CDM"},{"code":"72611074001","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx72611074010","type":"CDM"},{"code":"72611074010","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72611076101","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"72611076101","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72611076110","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"72611076110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72611076501","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"72611076501","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72611076510","type":"CDM"},{"code":"J3373","type":"HCPCS"},{"code":"72611076510","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM CHLORIDE POWDER PACKET 20 MEQ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888002406","type":"CDM"},{"code":"72888002406","type":"NDC"}],"standard_charges":[{"gross_charge":12.94,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CARVEDILOL TAB 3.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx72888003401","type":"CDM"},{"code":"72888003401","type":"NDC"}],"standard_charges":[{"gross_charge":10.16,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM BROMIDE NASAL SOLN 0.03% (21 MCG/SPRAY)","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx72888014938","type":"CDM"},{"code":"72888014938","type":"NDC"}],"standard_charges":[{"gross_charge":106.73,"discounted_cash":74.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ULIPRISTAL ACETATE TAB 30 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx73302045601","type":"CDM"},{"code":"73302045601","type":"NDC"}],"standard_charges":[{"gross_charge":76.56,"discounted_cash":53.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MELATONIN TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx74312002832","type":"CDM"},{"code":"74312002832","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIPTORELIN PAMOATE FOR IM SUSP 11.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx74676590400","type":"CDM"},{"code":"J3315","type":"HCPCS"},{"code":"74676590400","type":"NDC"}],"standard_charges":[{"gross_charge":8711.36,"discounted_cash":6097.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIPTORELIN PAMOATE FOR IM SUSP 11.25 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx74676590401","type":"CDM"},{"code":"J3315","type":"HCPCS"},{"code":"74676590401","type":"NDC"}],"standard_charges":[{"gross_charge":8714.21,"discounted_cash":6099.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIPTORELIN PAMOATE FOR IM SUSP 22.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx74676590600","type":"CDM"},{"code":"J3315","type":"HCPCS"},{"code":"74676590600","type":"NDC"}],"standard_charges":[{"gross_charge":17428.43,"discounted_cash":12199.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRIPTORELIN PAMOATE FOR IM SUSP 22.5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx74676590601","type":"CDM"},{"code":"J3315","type":"HCPCS"},{"code":"74676590601","type":"NDC"}],"standard_charges":[{"gross_charge":17428.43,"discounted_cash":12199.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENAZOPYRIDINE HCL TAB 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75826011410","type":"CDM"},{"code":"75826011410","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VERAPAMIL HCL TAB ER 180 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75834015801","type":"CDM"},{"code":"75834015801","type":"NDC"}],"standard_charges":[{"gross_charge":10.54,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM IODIDE ORAL SOLN 1 GM/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx75834028030","type":"CDM"},{"code":"75834028030","type":"NDC"}],"standard_charges":[{"gross_charge":540.6,"discounted_cash":378.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"THYROID TAB 60 MG (1 GRAIN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75834031201","type":"CDM"},{"code":"75834031201","type":"NDC"}],"standard_charges":[{"gross_charge":11.28,"discounted_cash":7.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx75907002311","type":"CDM"},{"code":"75907002311","type":"NDC"}],"standard_charges":[{"gross_charge":25.21,"discounted_cash":17.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76014000310","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"76014000310","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NEOSTIGMINE METHYLSULFATE IV SOLN 10 MG/10 ML (1 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76014000333","type":"CDM"},{"code":"J2710","type":"HCPCS"},{"code":"76014000333","type":"NDC"}],"standard_charges":[{"gross_charge":1816.66,"discounted_cash":1271.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENYLEPHRINE HCL IV SOLN 10 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76014000430","type":"CDM"},{"code":"J2371","type":"HCPCS"},{"code":"76014000430","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx76014000525","type":"CDM"},{"code":"76014000525","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPHEDRINE SULFATE IV SOLN 50 MG/ML","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"Rx76014000530","type":"CDM"},{"code":"76014000530","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE-NACL SOL PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 2 MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76045000410","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000410","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE INJ 4 MG/ML","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"Rx76045000511","type":"CDM"},{"code":"J2272","type":"HCPCS"},{"code":"76045000511","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000901","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000901","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000905","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000905","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000906","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000906","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000910","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000910","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000911","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000911","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYDROMORPHONE HCL INJ 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76045000996","type":"CDM"},{"code":"J1171","type":"HCPCS"},{"code":"76045000996","type":"NDC"}],"standard_charges":[{"gross_charge":108.16,"discounted_cash":75.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76125079210","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"76125079210","type":"NDC"}],"standard_charges":[{"gross_charge":539.01,"discounted_cash":377.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUMIN, HUMAN INJ 25%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76125079211","type":"CDM"},{"code":"P9047","type":"HCPCS"},{"code":"76125079211","type":"NDC"}],"standard_charges":[{"gross_charge":539.01,"discounted_cash":377.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx76204010001","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"76204010001","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM BROMIDE INHAL SOLN 0.02%","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"Rx76204010025","type":"CDM"},{"code":"J7644","type":"HCPCS"},{"code":"76204010025","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML)","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"Rx76204020001","type":"CDM"},{"code":"J7613","type":"HCPCS"},{"code":"76204020001","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204060001","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"76204060001","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"Rx76204060030","type":"CDM"},{"code":"J7620","type":"HCPCS"},{"code":"76204060030","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"Rx76329124001","type":"CDM"},{"code":"J3430","type":"HCPCS"},{"code":"76329124001","type":"NDC"}],"standard_charges":[{"gross_charge":347.98,"discounted_cash":243.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx76329146901","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"76329146901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MORPHINE SULFATE IV SOLN 1 MG/ML,MORPHINE SULFATE IV SOLN PF 1 MG/ML","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"Rx76329191201","type":"CDM"},{"code":"J2270","type":"HCPCS"},{"code":"76329191201","type":"NDC"}],"standard_charges":[{"gross_charge":141.64,"discounted_cash":99.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx76329301105","type":"CDM"},{"code":"76329301105","type":"NDC"}],"standard_charges":[{"gross_charge":70.29,"discounted_cash":49.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx76329301205","type":"CDM"},{"code":"76329301205","type":"NDC"}],"standard_charges":[{"gross_charge":72.27,"discounted_cash":50.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76329301305","type":"CDM"},{"code":"76329301305","type":"NDC"}],"standard_charges":[{"gross_charge":73.15,"discounted_cash":51.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76329330101","type":"CDM"},{"code":"76329330101","type":"NDC"}],"standard_charges":[{"gross_charge":164.95,"discounted_cash":115.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DEXTROSE INJ 50%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76329330201","type":"CDM"},{"code":"76329330201","type":"NDC"}],"standard_charges":[{"gross_charge":175.58,"discounted_cash":122.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM CHLORIDE INJ 10%","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx76329330401","type":"CDM"},{"code":"76329330401","type":"NDC"}],"standard_charges":[{"gross_charge":138.48,"discounted_cash":96.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76329331601","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"76329331601","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx76329331801","type":"CDM"},{"code":"J0165","type":"HCPCS"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"Rx76329333901","type":"CDM"},{"code":"J0461","type":"HCPCS"},{"code":"76329333901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE IV SOLN 8.4%","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"Rx76329335201","type":"CDM"},{"code":"76329335201","type":"NDC"}],"standard_charges":[{"gross_charge":259.17,"discounted_cash":181.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"Rx76329336901","type":"CDM"},{"code":"J2312","type":"HCPCS"},{"code":"76329336901","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 60 MG/3ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 200 MG/10ML (2%),LIDOCAINE HCL LOCAL IV SOLN PREF SYRINGE 100 MG/5ML (2%)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx76329339001","type":"CDM"},{"code":"J2003","type":"HCPCS"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"gross_charge":105.73,"discounted_cash":74.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000),EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/ML","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"Rx76329906000","type":"CDM"},{"code":"76329906000","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"HYOSCYAMINE SULFATE SL TAB 0.125 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx76439030910","type":"CDM"},{"code":"76439030910","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333003120","type":"CDM"},{"code":"77333003120","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN TAB DELAYED RELEASE 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333003125","type":"CDM"},{"code":"77333003125","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ASPIRIN CHEW TAB 81 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333004925","type":"CDM"},{"code":"77333004925","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"OMEGA-3 FATTY ACIDS CAP 1000 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333030825","type":"CDM"},{"code":"77333030825","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MELATONIN TAB 3 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333051625","type":"CDM"},{"code":"77333051625","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333081210","type":"CDM"},{"code":"77333081210","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SIMETHICONE CHEW TAB 80 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333081225","type":"CDM"},{"code":"77333081225","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333082725","type":"CDM"},{"code":"77333082725","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333083110","type":"CDM"},{"code":"77333083110","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM BICARBONATE TAB 650 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333083125","type":"CDM"},{"code":"77333083125","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333083510","type":"CDM"},{"code":"77333083510","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SODIUM CHLORIDE TAB 1 GM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333083525","type":"CDM"},{"code":"77333083525","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333086110","type":"CDM"},{"code":"77333086110","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333086125","type":"CDM"},{"code":"77333086125","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CYANOCOBALAMIN TAB 1000 MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333093825","type":"CDM"},{"code":"77333093825","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PYRIDOXINE HCL TAB 50 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333094025","type":"CDM"},{"code":"77333094025","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VITAMIN E CAP 180 MG (400 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333095110","type":"CDM"},{"code":"77333095110","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"VITAMIN E CAP 180 MG (400 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333095125","type":"CDM"},{"code":"77333095125","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZINC SULFATE CAP 220 MG (50 MG ELEMENTAL ZN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333098310","type":"CDM"},{"code":"77333098310","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"ZINC SULFATE CAP 220 MG (50 MG ELEMENTAL ZN)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx77333098325","type":"CDM"},{"code":"77333098325","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BENZOCAINE-MENTHOL LOZENGE 6-10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78112001266","type":"CDM"},{"code":"78112001266","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PHENOL LIQUID 1.4%","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"Rx78112069480","type":"CDM"},{"code":"78112069480","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MOMETASONE FUROATE INHAL POWD 220 MCG/ACT (BREATH ACTIVATED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206011403","type":"CDM"},{"code":"78206011403","type":"NDC"}],"standard_charges":[{"gross_charge":152.81,"discounted_cash":106.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"Rx78206011801","type":"CDM"},{"code":"J0702","type":"HCPCS"},{"code":"78206011801","type":"NDC"}],"standard_charges":[{"gross_charge":127.16,"discounted_cash":89.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"INFLIXIMAB-ABDA FOR IV INJ 100 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx78206016201","type":"CDM"},{"code":"Q5104","type":"HCPCS"},{"code":"78206016201","type":"NDC"}],"standard_charges":[{"gross_charge":1444.93,"discounted_cash":1011.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MELATONIN TAB 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681004100","type":"CDM"},{"code":"80681004100","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SKIN PROTECTANTS MISC - CREAM","drug_information":{"unit":113.0,"type":"GM"},"code_information":[{"code":"Rx80681015500","type":"CDM"},{"code":"80681015500","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MULTIPLE VITAMINS W/ MINERALS TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681016000","type":"CDM"},{"code":"80681016000","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES POWDER PACK 280-160-250 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx80681017200","type":"CDM"},{"code":"80681017200","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CALCIUM GLUCONATE INJ 10%","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx80830167201","type":"CDM"},{"code":"J0612","type":"HCPCS"},{"code":"80830167201","type":"NDC"}],"standard_charges":[{"gross_charge":728.85,"discounted_cash":510.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IBUPROFEN SUSP 100 MG/5ML","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81033001805","type":"CDM"},{"code":"81033001805","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MUPIROCIN OINT 2%","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"Rx81033002099","type":"CDM"},{"code":"81033002099","type":"NDC"}],"standard_charges":[{"gross_charge":57.08,"discounted_cash":39.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx81033010210","type":"CDM"},{"code":"81033010210","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"GUAIFENESIN LIQUID 100 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx81033010252","type":"CDM"},{"code":"81033010252","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"SENNOSIDES SYRUP 8.8 MG/5ML","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"Rx81033012005","type":"CDM"},{"code":"81033012005","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx81284041100","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"81284041100","type":"NDC"}],"standard_charges":[{"gross_charge":160.3,"discounted_cash":112.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"Rx81284041105","type":"CDM"},{"code":"J1110","type":"HCPCS"},{"code":"81284041105","type":"NDC"}],"standard_charges":[{"gross_charge":176.76,"discounted_cash":123.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81284061100","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"81284061100","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"Rx81284061110","type":"CDM"},{"code":"J3290","type":"HCPCS"},{"code":"81284061110","type":"NDC"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BISACODYL TAB DELAYED RELEASE 5 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx81421002001","type":"CDM"},{"code":"81421002001","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BISACODYL SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx81421002101","type":"CDM"},{"code":"81421002101","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BISACODYL SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx81421002102","type":"CDM"},{"code":"81421002102","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"BISACODYL SUPPOS 10 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx81421002103","type":"CDM"},{"code":"81421002103","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"LIDOCAINE PATCH 5%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82347050504","type":"CDM"},{"code":"82347050504","type":"NDC"}],"standard_charges":[{"gross_charge":15.07,"discounted_cash":10.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"NALOXEGOL OXALATE TAB 25 MG (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82625880201","type":"CDM"},{"code":"82625880201","type":"NDC"}],"standard_charges":[{"gross_charge":35.06,"discounted_cash":24.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"APRACLONIDINE HCL OPHTH SOLN 1% (BASE EQUIVALENT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx82667020001","type":"CDM"},{"code":"82667020001","type":"NDC"}],"standard_charges":[{"gross_charge":57.66,"discounted_cash":40.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx83634010220","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"83634010220","type":"NDC"}],"standard_charges":[{"gross_charge":102.04,"discounted_cash":71.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx83634010241","type":"CDM"},{"code":"J2540","type":"HCPCS"},{"code":"83634010241","type":"NDC"}],"standard_charges":[{"gross_charge":102.01,"discounted_cash":71.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 125 MCG (5000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx96295012846","type":"CDM"},{"code":"96295012846","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"CHOLECALCIFEROL TAB 25 MCG (1000 UNIT)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx96295012848","type":"CDM"},{"code":"96295012848","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"MENTHOL LOZENGE 5.8 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx96295013172","type":"CDM"},{"code":"96295013172","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"PSYLLIUM POWDER PACKET 51.7%","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"Rx96295013533","type":"CDM"},{"code":"96295013533","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION"}]},{"description":"IMP KNEE IB2 CCK TIB ARTICULAT","code_information":[{"code":"Sx00 5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"294411","type":"LOCAL"},{"code":"421540","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 294411 = Hospital System Supply Identifier | 421540 = Lawson ID"}]},{"description":"K-WIRE STYLE 7 - 1.1MM X 102MM","code_information":[{"code":"Sx00-0186-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"673259","type":"LOCAL"},{"code":"736661","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.25,"discounted_cash":49.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 673259 = Hospital System Supply Identifier | 736661 = Lawson ID"}]},{"description":"K-WIRE STYLE 1 - 1.6MM X 229MM","code_information":[{"code":"Sx00-0186-078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"673257","type":"LOCAL"},{"code":"736659","type":"LOCAL"}],"standard_charges":[{"gross_charge":71.25,"discounted_cash":49.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 673257 = Hospital System Supply Identifier | 736659 = Lawson ID"}]},{"description":"PLATE L1 ORTHOG BSSO LADR 39MM","code_information":[{"code":"Sx00-020-09-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"743218","type":"LOCAL"},{"code":"773375","type":"LOCAL"}],"standard_charges":[{"gross_charge":1227.39,"discounted_cash":859.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 743218 = Hospital System Supply Identifier | 773375 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38900","type":"LOCAL"},{"code":"245971","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38900 = Hospital System Supply Identifier | 245971 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38899","type":"LOCAL"},{"code":"245970","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38899 = Hospital System Supply Identifier | 245970 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 6IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38897","type":"LOCAL"},{"code":"245961","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38897 = Hospital System Supply Identifier | 245961 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5-1/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38895","type":"LOCAL"},{"code":"245959","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38895 = Hospital System Supply Identifier | 245959 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38894","type":"LOCAL"},{"code":"245958","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38894 = Hospital System Supply Identifier | 245958 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38893","type":"LOCAL"},{"code":"245957","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38893 = Hospital System Supply Identifier | 245957 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38892","type":"LOCAL"},{"code":"245956","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38892 = Hospital System Supply Identifier | 245956 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 5-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38896","type":"LOCAL"},{"code":"245960","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38896 = Hospital System Supply Identifier | 245960 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38890","type":"LOCAL"},{"code":"245954","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38890 = Hospital System Supply Identifier | 245954 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-1/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38889","type":"LOCAL"},{"code":"245953","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38889 = Hospital System Supply Identifier | 245953 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38888","type":"LOCAL"},{"code":"245952","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38888 = Hospital System Supply Identifier | 245952 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4-1/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38891","type":"LOCAL"},{"code":"245955","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38891 = Hospital System Supply Identifier | 245955 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 3IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38887","type":"LOCAL"},{"code":"245951","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38887 = Hospital System Supply Identifier | 245951 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 2-3/4IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38886","type":"LOCAL"},{"code":"245950","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38886 = Hospital System Supply Identifier | 245950 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 2-1/2IN","code_information":[{"code":"Sx00-0281-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38885","type":"LOCAL"},{"code":"245949","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38885 = Hospital System Supply Identifier | 245949 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 6IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62213","type":"LOCAL"},{"code":"245948","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62213 = Hospital System Supply Identifier | 245948 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5-3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62212","type":"LOCAL"},{"code":"245947","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62212 = Hospital System Supply Identifier | 245947 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5-1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62211","type":"LOCAL"},{"code":"245946","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62211 = Hospital System Supply Identifier | 245946 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5-1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62210","type":"LOCAL"},{"code":"245945","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62210 = Hospital System Supply Identifier | 245945 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 5IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62209","type":"LOCAL"},{"code":"245944","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62209 = Hospital System Supply Identifier | 245944 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 4-3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62208","type":"LOCAL"},{"code":"245943","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62208 = Hospital System Supply Identifier | 245943 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 4-1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62207","type":"LOCAL"},{"code":"245942","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62207 = Hospital System Supply Identifier | 245942 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62214","type":"LOCAL"},{"code":"245969","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62214 = Hospital System Supply Identifier | 245969 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 2-1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62205","type":"LOCAL"},{"code":"245940","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62205 = Hospital System Supply Identifier | 245940 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62203","type":"LOCAL"},{"code":"245927","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62203 = Hospital System Supply Identifier | 245927 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3 1/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62202","type":"LOCAL"},{"code":"245926","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62202 = Hospital System Supply Identifier | 245926 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 3IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62201","type":"LOCAL"},{"code":"245923","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62201 = Hospital System Supply Identifier | 245923 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62200","type":"LOCAL"},{"code":"245922","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62200 = Hospital System Supply Identifier | 245922 = Lawson ID"}]},{"description":"PIN KNOWLES 5/32 X 4 1/2IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62199","type":"LOCAL"},{"code":"245920","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62199 = Hospital System Supply Identifier | 245920 = Lawson ID"}]},{"description":"PIN KNOWLES 3/16 X 2-3/4IN","code_information":[{"code":"Sx00-0281-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62206","type":"LOCAL"},{"code":"245941","type":"LOCAL"}],"standard_charges":[{"gross_charge":437.5,"discounted_cash":306.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62206 = Hospital System Supply Identifier | 245941 = Lawson ID"}]},{"description":"DISC - PIN STNMN 2.4MMX60CM","code_information":[{"code":"Sx00-0409-021","type":"CDM"},{"code":"272","type":"RC"},{"code":"384645","type":"LOCAL"},{"code":"417181","type":"LOCAL"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384645 = Hospital System Supply Identifier | 417181 = Lawson ID"}]},{"description":"PIN STEINMANN 3.2X60","code_information":[{"code":"Sx00-0409-022","type":"CDM"},{"code":"272","type":"RC"},{"code":"151398","type":"LOCAL"},{"code":"437117","type":"LOCAL"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 151398 = Hospital System Supply Identifier | 437117 = Lawson ID"}]},{"description":"PIN STNMN 4.0MMX60CM","code_information":[{"code":"Sx00-0409-023","type":"CDM"},{"code":"272","type":"RC"},{"code":"384646","type":"LOCAL"},{"code":"417182","type":"LOCAL"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384646 = Hospital System Supply Identifier | 417182 = Lawson ID"}]},{"description":"GUIDEWIRE ORTHOPEDIC 60CM 3.2MM 6MM NSTRL BULLET TIP ZIMALOY INTRAMEDULLARY NAIL","code_information":[{"code":"Sx00-0409-034","type":"CDM"},{"code":"272","type":"RC"},{"code":"384658","type":"LOCAL"},{"code":"418220","type":"LOCAL"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384658 = Hospital System Supply Identifier | 418220 = Lawson ID"}]},{"description":"GUIDEWIRE ORTHOPEDIC 60CM 2MM NSTRL SMOOTH ZIMALOY INTRAMEDULLARY NAIL","code_information":[{"code":"Sx00-0409-042","type":"CDM"},{"code":"272","type":"RC"},{"code":"383807","type":"LOCAL"},{"code":"402333","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383807 = Hospital System Supply Identifier | 402333 = Lawson ID"}]},{"description":"GUIDEWIRE ORTHOPEDIC 60CM 3.2MM NSTRL SMOOTH ZIMALOY INTRAMEDULLARY NAIL","code_information":[{"code":"Sx00-0409-043","type":"CDM"},{"code":"272","type":"RC"},{"code":"383808","type":"LOCAL"},{"code":"402334","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383808 = Hospital System Supply Identifier | 402334 = Lawson ID"}]},{"description":"DISC - COLLAR CERV SERP MED XLNG 3.5","code_information":[{"code":"Sx00-0737-005","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0120","type":"HCPCS"},{"code":"36519","type":"LOCAL"},{"code":"106778","type":"LOCAL"}],"standard_charges":[{"gross_charge":100.51,"discounted_cash":70.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36519 = Hospital System Supply Identifier | 106778 = Lawson ID"}]},{"description":"DUP USE S13371 - PIN RUSH MEDUL 1/4 801-01-03","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"62204","type":"LOCAL"},{"code":"245931","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 62204 = Hospital System Supply Identifier | 245931 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZI","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38869","type":"LOCAL"},{"code":"245915","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38869 = Hospital System Supply Identifier | 245915 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZH","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38868","type":"LOCAL"},{"code":"245914","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38868 = Hospital System Supply Identifier | 245914 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZG","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38867","type":"LOCAL"},{"code":"245913","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38867 = Hospital System Supply Identifier | 245913 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZF","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38866","type":"LOCAL"},{"code":"245912","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38866 = Hospital System Supply Identifier | 245912 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZA-2","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36573","type":"LOCAL"},{"code":"116023","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36573 = Hospital System Supply Identifier | 116023 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZD","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38864","type":"LOCAL"},{"code":"245910","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38864 = Hospital System Supply Identifier | 245910 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZC","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38863","type":"LOCAL"},{"code":"245909","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38863 = Hospital System Supply Identifier | 245909 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZA-1","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36982","type":"LOCAL"},{"code":"142730","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36982 = Hospital System Supply Identifier | 142730 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY A 28CMX6.4MM","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"28161","type":"LOCAL"},{"code":"116024","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 28161 = Hospital System Supply Identifier | 116024 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY 1/4 SZE","code_information":[{"code":"Sx00-0801-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38865","type":"LOCAL"},{"code":"245911","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38865 = Hospital System Supply Identifier | 245911 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-09","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"46788","type":"LOCAL"},{"code":"206201","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 46788 = Hospital System Supply Identifier | 206201 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY L 41.3CMX4.8MM","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31360","type":"LOCAL"},{"code":"328029","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31360 = Hospital System Supply Identifier | 328029 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-10","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68375","type":"LOCAL"},{"code":"206202","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68375 = Hospital System Supply Identifier | 206202 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-03","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68374","type":"LOCAL"},{"code":"206200","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68374 = Hospital System Supply Identifier | 206200 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-08","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65330","type":"LOCAL"},{"code":"147124","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65330 = Hospital System Supply Identifier | 147124 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY D 26CMX4.8MM","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"3903","type":"LOCAL"},{"code":"147122","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 3903 = Hospital System Supply Identifier | 147122 = Lawson ID"}]},{"description":"PIN RUSH MEDUL 3/16 802-01-06","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65136","type":"LOCAL"},{"code":"142731","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65136 = Hospital System Supply Identifier | 142731 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-04","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"61895","type":"LOCAL"},{"code":"116020","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 61895 = Hospital System Supply Identifier | 116020 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY A 20.3CMX4.8MM","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"28160","type":"LOCAL"},{"code":"116019","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 28160 = Hospital System Supply Identifier | 116019 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/16 802-01-07","code_information":[{"code":"Sx00-0802-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65329","type":"LOCAL"},{"code":"147123","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65329 = Hospital System Supply Identifier | 147123 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-14","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68361","type":"LOCAL"},{"code":"206187","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68361 = Hospital System Supply Identifier | 206187 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-13","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68360","type":"LOCAL"},{"code":"206186","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68360 = Hospital System Supply Identifier | 206186 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-10","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68358","type":"LOCAL"},{"code":"206184","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68358 = Hospital System Supply Identifier | 206184 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-07","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68357","type":"LOCAL"},{"code":"206183","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68357 = Hospital System Supply Identifier | 206183 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-04","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68356","type":"LOCAL"},{"code":"206182","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68356 = Hospital System Supply Identifier | 206182 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-03","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68355","type":"LOCAL"},{"code":"206181","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68355 = Hospital System Supply Identifier | 206181 = Lawson ID"}]},{"description":"PIN RUSH MEDUL 1/8 803-01-11","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68359","type":"LOCAL"},{"code":"206185","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68359 = Hospital System Supply Identifier | 206185 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-08","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65334","type":"LOCAL"},{"code":"147128","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65334 = Hospital System Supply Identifier | 147128 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-06","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65333","type":"LOCAL"},{"code":"147127","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65333 = Hospital System Supply Identifier | 147127 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-05","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65332","type":"LOCAL"},{"code":"147126","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65332 = Hospital System Supply Identifier | 147126 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-02","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65331","type":"LOCAL"},{"code":"147125","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65331 = Hospital System Supply Identifier | 147125 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-12","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"61896","type":"LOCAL"},{"code":"116021","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 61896 = Hospital System Supply Identifier | 116021 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 1/8 803-01-09","code_information":[{"code":"Sx00-0803-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65335","type":"LOCAL"},{"code":"147129","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65335 = Hospital System Supply Identifier | 147129 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-13","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68372","type":"LOCAL"},{"code":"206198","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68372 = Hospital System Supply Identifier | 206198 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-12","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68371","type":"LOCAL"},{"code":"206197","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68371 = Hospital System Supply Identifier | 206197 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-11","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68370","type":"LOCAL"},{"code":"206196","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68370 = Hospital System Supply Identifier | 206196 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-10","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68369","type":"LOCAL"},{"code":"206195","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68369 = Hospital System Supply Identifier | 206195 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-09","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68368","type":"LOCAL"},{"code":"206194","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68368 = Hospital System Supply Identifier | 206194 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-08","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68367","type":"LOCAL"},{"code":"206193","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68367 = Hospital System Supply Identifier | 206193 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-05","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68364","type":"LOCAL"},{"code":"206190","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68364 = Hospital System Supply Identifier | 206190 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-06","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68365","type":"LOCAL"},{"code":"206191","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68365 = Hospital System Supply Identifier | 206191 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-04","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68363","type":"LOCAL"},{"code":"206189","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68363 = Hospital System Supply Identifier | 206189 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-03","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68362","type":"LOCAL"},{"code":"206188","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68362 = Hospital System Supply Identifier | 206188 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-02","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65336","type":"LOCAL"},{"code":"147130","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65336 = Hospital System Supply Identifier | 147130 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-14","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68373","type":"LOCAL"},{"code":"206199","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68373 = Hospital System Supply Identifier | 206199 = Lawson ID"}]},{"description":"DISC - PIN RUSH MEDUL 3/32 804-01-07","code_information":[{"code":"Sx00-0804-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68366","type":"LOCAL"},{"code":"206192","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68366 = Hospital System Supply Identifier | 206192 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY X 24.1CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2140","type":"LOCAL"},{"code":"339793","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2140 = Hospital System Supply Identifier | 339793 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY W 22.9CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2138","type":"LOCAL"},{"code":"339792","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2138 = Hospital System Supply Identifier | 339792 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY U 20.3CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2136","type":"LOCAL"},{"code":"339790","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2136 = Hospital System Supply Identifier | 339790 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY Y 25.4CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2172","type":"LOCAL"},{"code":"339794","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2172 = Hospital System Supply Identifier | 339794 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY T 19.1CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2135","type":"LOCAL"},{"code":"339789","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2135 = Hospital System Supply Identifier | 339789 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY V 21.6CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2137","type":"LOCAL"},{"code":"339791","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2137 = Hospital System Supply Identifier | 339791 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY R 16.5CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2133","type":"LOCAL"},{"code":"339787","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2133 = Hospital System Supply Identifier | 339787 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY Q 15.2CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2132","type":"LOCAL"},{"code":"339786","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2132 = Hospital System Supply Identifier | 339786 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY S 17.8CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2134","type":"LOCAL"},{"code":"339788","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2134 = Hospital System Supply Identifier | 339788 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY P 14.0CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2131","type":"LOCAL"},{"code":"339785","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2131 = Hospital System Supply Identifier | 339785 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY O 12.7CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2130","type":"LOCAL"},{"code":"339784","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2130 = Hospital System Supply Identifier | 339784 = Lawson ID"}]},{"description":"DISC - PIN RUSH MDLLRY N 11.4CMX2.4MM","code_information":[{"code":"Sx00-0806-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2129","type":"LOCAL"},{"code":"339783","type":"LOCAL"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":283.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2129 = Hospital System Supply Identifier | 339783 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 2H LT","code_information":[{"code":"Sx00-0903-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877606","type":"LOCAL"},{"code":"876275","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877606 = Hospital System Supply Identifier | 876275 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 3H LT","code_information":[{"code":"Sx00-0903-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877607","type":"LOCAL"},{"code":"876276","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877607 = Hospital System Supply Identifier | 876276 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 4H LT","code_information":[{"code":"Sx00-0903-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877608","type":"LOCAL"},{"code":"876277","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877608 = Hospital System Supply Identifier | 876277 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 4H RT","code_information":[{"code":"Sx00-0903-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877611","type":"LOCAL"},{"code":"876280","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877611 = Hospital System Supply Identifier | 876280 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 2H RT","code_information":[{"code":"Sx00-0903-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877609","type":"LOCAL"},{"code":"876278","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877609 = Hospital System Supply Identifier | 876278 = Lawson ID"}]},{"description":"PLT ANTLAT DST TIB 3.5MM 3H RT","code_information":[{"code":"Sx00-0903-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877610","type":"LOCAL"},{"code":"876279","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877610 = Hospital System Supply Identifier | 876279 = Lawson ID"}]},{"description":"SCREW SLF-TP 3.5X12MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"636096","type":"LOCAL"},{"code":"711671","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 636096 = Hospital System Supply Identifier | 711671 = Lawson ID"}]},{"description":"SCREW SLF-TP 3.5X14MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"636097","type":"LOCAL"},{"code":"711672","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 636097 = Hospital System Supply Identifier | 711672 = Lawson ID"}]},{"description":"SCREW SLF-TP 3.5X16MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"636098","type":"LOCAL"},{"code":"711673","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 636098 = Hospital System Supply Identifier | 711673 = Lawson ID"}]},{"description":"SCREW BONE 3.5X18 CORT NON LOK","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934131","type":"LOCAL"},{"code":"787027","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934131 = Hospital System Supply Identifier | 787027 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 10MM","code_information":[{"code":"Sx00-0903-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877612","type":"LOCAL"},{"code":"876281","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877612 = Hospital System Supply Identifier | 876281 = Lawson ID"}]},{"description":"SCREW BONE 3.5X26CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934135","type":"LOCAL"},{"code":"829511","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934135 = Hospital System Supply Identifier | 829511 = Lawson ID"}]},{"description":"SCREW BONE 3.5X22CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934133","type":"LOCAL"},{"code":"816524","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934133 = Hospital System Supply Identifier | 816524 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 28MM","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877613","type":"LOCAL"},{"code":"876282","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877613 = Hospital System Supply Identifier | 876282 = Lawson ID"}]},{"description":"SCREW BONE 3.5X24CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934134","type":"LOCAL"},{"code":"816522","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934134 = Hospital System Supply Identifier | 816522 = Lawson ID"}]},{"description":"SCREW BONE 3.5X20CORT NON LOCK","code_information":[{"code":"Sx00-0903-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934132","type":"LOCAL"},{"code":"816523","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934132 = Hospital System Supply Identifier | 816523 = Lawson ID"}]},{"description":"SCREW BONE 3.5X36CORT NON LOCK","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934137","type":"LOCAL"},{"code":"816521","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934137 = Hospital System Supply Identifier | 816521 = Lawson ID"}]},{"description":"SCREW BONE 3.5X32CORT NON LOCK","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934136","type":"LOCAL"},{"code":"816525","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934136 = Hospital System Supply Identifier | 816525 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 30MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877614","type":"LOCAL"},{"code":"876283","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877614 = Hospital System Supply Identifier | 876283 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 34MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877615","type":"LOCAL"},{"code":"876284","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877615 = Hospital System Supply Identifier | 876284 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MMS HEX 35MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877616","type":"LOCAL"},{"code":"876285","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877616 = Hospital System Supply Identifier | 876285 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 38MM","code_information":[{"code":"Sx00-0903-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877617","type":"LOCAL"},{"code":"876286","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877617 = Hospital System Supply Identifier | 876286 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 48MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877622","type":"LOCAL"},{"code":"876291","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877622 = Hospital System Supply Identifier | 876291 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX, 45MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877621","type":"LOCAL"},{"code":"876290","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877621 = Hospital System Supply Identifier | 876290 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 44MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877620","type":"LOCAL"},{"code":"876289","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877620 = Hospital System Supply Identifier | 876289 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 40MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877618","type":"LOCAL"},{"code":"876287","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877618 = Hospital System Supply Identifier | 876287 = Lawson ID"}]},{"description":"SCREW BONE 3.5X46 CORT NON-LOK","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934138","type":"LOCAL"},{"code":"800288","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934138 = Hospital System Supply Identifier | 800288 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 42MM","code_information":[{"code":"Sx00-0903-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877619","type":"LOCAL"},{"code":"876288","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877619 = Hospital System Supply Identifier | 876288 = Lawson ID"}]},{"description":"SCREW BONE 3.5X50 CORT NON-LOK","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934139","type":"LOCAL"},{"code":"784755","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934139 = Hospital System Supply Identifier | 784755 = Lawson ID"}]},{"description":"SCREW BONE 3.5X55 CORT NON-LOK","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934140","type":"LOCAL"},{"code":"784756","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934140 = Hospital System Supply Identifier | 784756 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 52MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877623","type":"LOCAL"},{"code":"876292","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877623 = Hospital System Supply Identifier | 876292 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 54MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877624","type":"LOCAL"},{"code":"876293","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877624 = Hospital System Supply Identifier | 876293 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 56MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877625","type":"LOCAL"},{"code":"876294","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877625 = Hospital System Supply Identifier | 876294 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 58MM","code_information":[{"code":"Sx00-0903-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877626","type":"LOCAL"},{"code":"876295","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877626 = Hospital System Supply Identifier | 876295 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 65MM","code_information":[{"code":"Sx00-0903-256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877628","type":"LOCAL"},{"code":"876297","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877628 = Hospital System Supply Identifier | 876297 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 60MM","code_information":[{"code":"Sx00-0903-256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877627","type":"LOCAL"},{"code":"876296","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877627 = Hospital System Supply Identifier | 876296 = Lawson ID"}]},{"description":"SCREW S/T CORT 3.5MM HEX 70MM","code_information":[{"code":"Sx00-0903-257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877629","type":"LOCAL"},{"code":"876298","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877629 = Hospital System Supply Identifier | 876298 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 12MM","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877630","type":"LOCAL"},{"code":"876299","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877630 = Hospital System Supply Identifier | 876299 = Lawson ID"}]},{"description":"SCREW BONE T15 103.5BLU NSTRL","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934141","type":"LOCAL"},{"code":"827838","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934141 = Hospital System Supply Identifier | 827838 = Lawson ID"}]},{"description":"SCREW BONE 143.5NSTRL T15 HEXA","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934142","type":"LOCAL"},{"code":"827839","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934142 = Hospital System Supply Identifier | 827839 = Lawson ID"}]},{"description":"SCREW BONE 3.5X16CORT LOCKING","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934143","type":"LOCAL"},{"code":"816519","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934143 = Hospital System Supply Identifier | 816519 = Lawson ID"}]},{"description":"SCREW BONE 3.5X18CORT LOCKING","code_information":[{"code":"Sx00-0903-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934144","type":"LOCAL"},{"code":"816517","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934144 = Hospital System Supply Identifier | 816517 = Lawson ID"}]},{"description":"SCREW BONE 3.5X20CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934145","type":"LOCAL"},{"code":"816518","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934145 = Hospital System Supply Identifier | 816518 = Lawson ID"}]},{"description":"SCREW BONE 3.5X22CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934146","type":"LOCAL"},{"code":"816520","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934146 = Hospital System Supply Identifier | 816520 = Lawson ID"}]},{"description":"SCREW BONE 3.5X26CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934147","type":"LOCAL"},{"code":"829509","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934147 = Hospital System Supply Identifier | 829509 = Lawson ID"}]},{"description":"SCREW BONE 3.5X28CORT LOCKING","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934148","type":"LOCAL"},{"code":"830987","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934148 = Hospital System Supply Identifier | 830987 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 24MM","code_information":[{"code":"Sx00-0903-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877631","type":"LOCAL"},{"code":"876300","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877631 = Hospital System Supply Identifier | 876300 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 38MM","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877634","type":"LOCAL"},{"code":"876303","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877634 = Hospital System Supply Identifier | 876303 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 35MM","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877633","type":"LOCAL"},{"code":"876302","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877633 = Hospital System Supply Identifier | 876302 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 34MM","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877632","type":"LOCAL"},{"code":"876301","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877632 = Hospital System Supply Identifier | 876301 = Lawson ID"}]},{"description":"SCREW BONE 3.5X36CORT LOCKING","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934151","type":"LOCAL"},{"code":"829586","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934151 = Hospital System Supply Identifier | 829586 = Lawson ID"}]},{"description":"SCREW BONE 3.5X30CORT LOCKING","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934149","type":"LOCAL"},{"code":"829510","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934149 = Hospital System Supply Identifier | 829510 = Lawson ID"}]},{"description":"SCREW BONE 3.5X32CORT LOCKING","code_information":[{"code":"Sx00-0903-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934150","type":"LOCAL"},{"code":"830988","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934150 = Hospital System Supply Identifier | 830988 = Lawson ID"}]},{"description":"SCREW BONE 3.5X40CORT LOCKING","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934152","type":"LOCAL"},{"code":"829587","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934152 = Hospital System Supply Identifier | 829587 = Lawson ID"}]},{"description":"SCREW BONE 3.5X44CORT LOCKING","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934153","type":"LOCAL"},{"code":"829588","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934153 = Hospital System Supply Identifier | 829588 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 42MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877635","type":"LOCAL"},{"code":"876304","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877635 = Hospital System Supply Identifier | 876304 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 45MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877636","type":"LOCAL"},{"code":"876305","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877636 = Hospital System Supply Identifier | 876305 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 46MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877637","type":"LOCAL"},{"code":"876306","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877637 = Hospital System Supply Identifier | 876306 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 48MM","code_information":[{"code":"Sx00-0903-264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877638","type":"LOCAL"},{"code":"876307","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877638 = Hospital System Supply Identifier | 876307 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 56MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877642","type":"LOCAL"},{"code":"876311","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877642 = Hospital System Supply Identifier | 876311 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 50MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877641","type":"LOCAL"},{"code":"876310","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877641 = Hospital System Supply Identifier | 876310 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 52MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877639","type":"LOCAL"},{"code":"876308","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877639 = Hospital System Supply Identifier | 876308 = Lawson ID"}]},{"description":"SCREW BONE 3.5X50CORT LOCKING","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934154","type":"LOCAL"},{"code":"829589","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934154 = Hospital System Supply Identifier | 829589 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 54MM","code_information":[{"code":"Sx00-0903-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877640","type":"LOCAL"},{"code":"876309","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877640 = Hospital System Supply Identifier | 876309 = Lawson ID"}]},{"description":"SCREW BONE 3.5X60CORT LOCKING","code_information":[{"code":"Sx00-0903-266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934155","type":"LOCAL"},{"code":"829590","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934155 = Hospital System Supply Identifier | 829590 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 65MM","code_information":[{"code":"Sx00-0903-266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877643","type":"LOCAL"},{"code":"876312","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877643 = Hospital System Supply Identifier | 876312 = Lawson ID"}]},{"description":"SCREW LOK CORT 3.5MM HEX 70MM","code_information":[{"code":"Sx00-0903-267","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877644","type":"LOCAL"},{"code":"876313","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877644 = Hospital System Supply Identifier | 876313 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 6H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877648","type":"LOCAL"},{"code":"876317","type":"LOCAL"}],"standard_charges":[{"gross_charge":10320.13,"discounted_cash":7224.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877648 = Hospital System Supply Identifier | 876317 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 8H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877649","type":"LOCAL"},{"code":"876318","type":"LOCAL"}],"standard_charges":[{"gross_charge":10320.13,"discounted_cash":7224.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877649 = Hospital System Supply Identifier | 876318 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 5H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877647","type":"LOCAL"},{"code":"876316","type":"LOCAL"}],"standard_charges":[{"gross_charge":7806.85,"discounted_cash":5464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877647 = Hospital System Supply Identifier | 876316 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 2H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877645","type":"LOCAL"},{"code":"876314","type":"LOCAL"}],"standard_charges":[{"gross_charge":7806.85,"discounted_cash":5464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877645 = Hospital System Supply Identifier | 876314 = Lawson ID"}]},{"description":"PLATE BONE NARROW 3.5LFT MEDIA","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934156","type":"LOCAL"},{"code":"816526","type":"LOCAL"}],"standard_charges":[{"gross_charge":7806.85,"discounted_cash":5464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934156 = Hospital System Supply Identifier | 816526 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 3H L","code_information":[{"code":"Sx00-0903-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877646","type":"LOCAL"},{"code":"876315","type":"LOCAL"}],"standard_charges":[{"gross_charge":7806.85,"discounted_cash":5464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877646 = Hospital System Supply Identifier | 876315 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 5H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877652","type":"LOCAL"},{"code":"876321","type":"LOCAL"}],"standard_charges":[{"gross_charge":7806.85,"discounted_cash":5464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877652 = Hospital System Supply Identifier | 876321 = Lawson ID"}]},{"description":"PLATE BONE NARROW 3.5RT MEDIAL","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934157","type":"LOCAL"},{"code":"816516","type":"LOCAL"}],"standard_charges":[{"gross_charge":7806.85,"discounted_cash":5464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934157 = Hospital System Supply Identifier | 816516 = Lawson ID"}]},{"description":"PLATE BONE NARROW 136NSTRL 8H","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934158","type":"LOCAL"},{"code":"827837","type":"LOCAL"}],"standard_charges":[{"gross_charge":10320.13,"discounted_cash":7224.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934158 = Hospital System Supply Identifier | 827837 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 2H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877650","type":"LOCAL"},{"code":"876319","type":"LOCAL"}],"standard_charges":[{"gross_charge":7806.85,"discounted_cash":5464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877650 = Hospital System Supply Identifier | 876319 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 3H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877651","type":"LOCAL"},{"code":"876320","type":"LOCAL"}],"standard_charges":[{"gross_charge":7806.85,"discounted_cash":5464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877651 = Hospital System Supply Identifier | 876320 = Lawson ID"}]},{"description":"PLT NRW MED DST TIB 3.5MM 6H R","code_information":[{"code":"Sx00-0903-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877653","type":"LOCAL"},{"code":"876322","type":"LOCAL"}],"standard_charges":[{"gross_charge":10320.13,"discounted_cash":7224.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877653 = Hospital System Supply Identifier | 876322 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 6H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877657","type":"LOCAL"},{"code":"876326","type":"LOCAL"}],"standard_charges":[{"gross_charge":10320.13,"discounted_cash":7224.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877657 = Hospital System Supply Identifier | 876326 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 8H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877658","type":"LOCAL"},{"code":"876327","type":"LOCAL"}],"standard_charges":[{"gross_charge":10320.13,"discounted_cash":7224.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877658 = Hospital System Supply Identifier | 876327 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 5H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877656","type":"LOCAL"},{"code":"876325","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877656 = Hospital System Supply Identifier | 876325 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 2H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877654","type":"LOCAL"},{"code":"876323","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877654 = Hospital System Supply Identifier | 876323 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 3H L","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877655","type":"LOCAL"},{"code":"876324","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877655 = Hospital System Supply Identifier | 876324 = Lawson ID"}]},{"description":"PLATE LT 4H 3.5WIDE MEDIAL DIS","code_information":[{"code":"Sx00-0903-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934159","type":"LOCAL"},{"code":"830989","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934159 = Hospital System Supply Identifier | 830989 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 2H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877659","type":"LOCAL"},{"code":"876328","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877659 = Hospital System Supply Identifier | 876328 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 3H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877660","type":"LOCAL"},{"code":"876329","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877660 = Hospital System Supply Identifier | 876329 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 4H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877661","type":"LOCAL"},{"code":"876330","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877661 = Hospital System Supply Identifier | 876330 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 5H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877662","type":"LOCAL"},{"code":"876331","type":"LOCAL"}],"standard_charges":[{"gross_charge":7155.7,"discounted_cash":5008.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877662 = Hospital System Supply Identifier | 876331 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 6H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877663","type":"LOCAL"},{"code":"876332","type":"LOCAL"}],"standard_charges":[{"gross_charge":10320.13,"discounted_cash":7224.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877663 = Hospital System Supply Identifier | 876332 = Lawson ID"}]},{"description":"PLT WDE MED DST TIB 3.5MM 8H R","code_information":[{"code":"Sx00-0903-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877664","type":"LOCAL"},{"code":"876333","type":"LOCAL"}],"standard_charges":[{"gross_charge":10320.13,"discounted_cash":7224.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877664 = Hospital System Supply Identifier | 876333 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X48MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877669","type":"LOCAL"},{"code":"876338","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877669 = Hospital System Supply Identifier | 876338 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X46MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877668","type":"LOCAL"},{"code":"876337","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877668 = Hospital System Supply Identifier | 876337 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X42MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877666","type":"LOCAL"},{"code":"876335","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877666 = Hospital System Supply Identifier | 876335 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X40MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877665","type":"LOCAL"},{"code":"876334","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877665 = Hospital System Supply Identifier | 876334 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X44MM 10MM","code_information":[{"code":"Sx00-0903-384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877667","type":"LOCAL"},{"code":"876336","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877667 = Hospital System Supply Identifier | 876336 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X50MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877670","type":"LOCAL"},{"code":"876339","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877670 = Hospital System Supply Identifier | 876339 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X52MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877671","type":"LOCAL"},{"code":"876340","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877671 = Hospital System Supply Identifier | 876340 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X54MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877672","type":"LOCAL"},{"code":"876341","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877672 = Hospital System Supply Identifier | 876341 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X56MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877673","type":"LOCAL"},{"code":"876342","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877673 = Hospital System Supply Identifier | 876342 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X58MM 10MM","code_information":[{"code":"Sx00-0903-385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877674","type":"LOCAL"},{"code":"876343","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877674 = Hospital System Supply Identifier | 876343 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X66MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877678","type":"LOCAL"},{"code":"876347","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877678 = Hospital System Supply Identifier | 876347 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X68MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877679","type":"LOCAL"},{"code":"876348","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877679 = Hospital System Supply Identifier | 876348 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X62MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877676","type":"LOCAL"},{"code":"876345","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877676 = Hospital System Supply Identifier | 876345 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X60MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877675","type":"LOCAL"},{"code":"876344","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877675 = Hospital System Supply Identifier | 876344 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X64MM 10MM","code_information":[{"code":"Sx00-0903-386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877677","type":"LOCAL"},{"code":"876346","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877677 = Hospital System Supply Identifier | 876346 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X70MM 10MM","code_information":[{"code":"Sx00-0903-387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877680","type":"LOCAL"},{"code":"876349","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877680 = Hospital System Supply Identifier | 876349 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X40MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877681","type":"LOCAL"},{"code":"876350","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877681 = Hospital System Supply Identifier | 876350 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X42MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877682","type":"LOCAL"},{"code":"876351","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877682 = Hospital System Supply Identifier | 876351 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X44MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877683","type":"LOCAL"},{"code":"876352","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877683 = Hospital System Supply Identifier | 876352 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X46MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877684","type":"LOCAL"},{"code":"876353","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877684 = Hospital System Supply Identifier | 876353 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X48MM 15MM","code_information":[{"code":"Sx00-0903-394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877685","type":"LOCAL"},{"code":"876354","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877685 = Hospital System Supply Identifier | 876354 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X58MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877690","type":"LOCAL"},{"code":"876359","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877690 = Hospital System Supply Identifier | 876359 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X50MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877686","type":"LOCAL"},{"code":"876355","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877686 = Hospital System Supply Identifier | 876355 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X52MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877687","type":"LOCAL"},{"code":"876356","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877687 = Hospital System Supply Identifier | 876356 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X54MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877688","type":"LOCAL"},{"code":"876357","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877688 = Hospital System Supply Identifier | 876357 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X56MM 15MM","code_information":[{"code":"Sx00-0903-395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877689","type":"LOCAL"},{"code":"876358","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877689 = Hospital System Supply Identifier | 876358 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X64MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877694","type":"LOCAL"},{"code":"876362","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877694 = Hospital System Supply Identifier | 876362 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X66MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877695","type":"LOCAL"},{"code":"876363","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877695 = Hospital System Supply Identifier | 876363 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X60MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877691","type":"LOCAL"},{"code":"876360","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877691 = Hospital System Supply Identifier | 876360 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X62MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877692","type":"LOCAL"},{"code":"876361","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877692 = Hospital System Supply Identifier | 876361 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X68MM 15MM","code_information":[{"code":"Sx00-0903-396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877696","type":"LOCAL"},{"code":"876364","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877696 = Hospital System Supply Identifier | 876364 = Lawson ID"}]},{"description":"SCREW T-PHYS LOK 3.5X70MM 15MM","code_information":[{"code":"Sx00-0903-397","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877697","type":"LOCAL"},{"code":"876365","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877697 = Hospital System Supply Identifier | 876365 = Lawson ID"}]},{"description":"PLATE BONE COMPRESSION NARROW 3 HOLE MEDIAL PEDILOC 0009036103 3.5MM","code_information":[{"code":"Sx00-0903-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175891","type":"LOCAL"},{"code":"1082536","type":"LOCAL"}],"standard_charges":[{"gross_charge":7806.85,"discounted_cash":5464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175891 = Hospital System Supply Identifier | 1082536 = Lawson ID"}]},{"description":"PLATE BONE COMPRESSION NARROW 3 HOLE MEDIAL PEDILOC 0009036203 3.5MM","code_information":[{"code":"Sx00-0903-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175776","type":"LOCAL"},{"code":"1082496","type":"LOCAL"}],"standard_charges":[{"gross_charge":7806.85,"discounted_cash":5464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175776 = Hospital System Supply Identifier | 1082496 = Lawson ID"}]},{"description":"PLATE INF 90D 3HL","code_information":[{"code":"Sx00-0907-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877698","type":"LOCAL"},{"code":"876366","type":"LOCAL"}],"standard_charges":[{"gross_charge":6688.0,"discounted_cash":4681.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877698 = Hospital System Supply Identifier | 876366 = Lawson ID"}]},{"description":"PLATE INF 110D 3HL","code_information":[{"code":"Sx00-0907-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877699","type":"LOCAL"},{"code":"876367","type":"LOCAL"}],"standard_charges":[{"gross_charge":6688.0,"discounted_cash":4681.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877699 = Hospital System Supply Identifier | 876367 = Lawson ID"}]},{"description":"PLATE INF 130D 3HL","code_information":[{"code":"Sx00-0907-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877700","type":"LOCAL"},{"code":"876368","type":"LOCAL"}],"standard_charges":[{"gross_charge":6688.0,"discounted_cash":4681.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877700 = Hospital System Supply Identifier | 876368 = Lawson ID"}]},{"description":"PLATE 90DX3.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877701","type":"LOCAL"},{"code":"876369","type":"LOCAL"}],"standard_charges":[{"gross_charge":6610.63,"discounted_cash":4627.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877701 = Hospital System Supply Identifier | 876369 = Lawson ID"}]},{"description":"PLATE 100DX3.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877702","type":"LOCAL"},{"code":"876370","type":"LOCAL"}],"standard_charges":[{"gross_charge":7391.6,"discounted_cash":5174.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877702 = Hospital System Supply Identifier | 876370 = Lawson ID"}]},{"description":"PLATE BONE 3.5110 DEG 6OFFSET","code_information":[{"code":"Sx00-0907-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934160","type":"LOCAL"},{"code":"829591","type":"LOCAL"}],"standard_charges":[{"gross_charge":7391.6,"discounted_cash":5174.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934160 = Hospital System Supply Identifier | 829591 = Lawson ID"}]},{"description":"PLATE 120DX3.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877703","type":"LOCAL"},{"code":"876371","type":"LOCAL"}],"standard_charges":[{"gross_charge":7391.6,"discounted_cash":5174.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877703 = Hospital System Supply Identifier | 876371 = Lawson ID"}]},{"description":"PLATE 90DX3.5MM 12MM OFF 3HL","code_information":[{"code":"Sx00-0907-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877704","type":"LOCAL"},{"code":"876372","type":"LOCAL"}],"standard_charges":[{"gross_charge":6821.3,"discounted_cash":4774.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877704 = Hospital System Supply Identifier | 876372 = Lawson ID"}]},{"description":"PLATE 100DX3.5MM 12MM OFF 3HL","code_information":[{"code":"Sx00-0907-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877705","type":"LOCAL"},{"code":"876373","type":"LOCAL"}],"standard_charges":[{"gross_charge":7391.6,"discounted_cash":5174.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877705 = Hospital System Supply Identifier | 876373 = Lawson ID"}]},{"description":"PLATE BONE 3.5110 DEG 12OFFSET","code_information":[{"code":"Sx00-0907-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934161","type":"LOCAL"},{"code":"829592","type":"LOCAL"}],"standard_charges":[{"gross_charge":7391.6,"discounted_cash":5174.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934161 = Hospital System Supply Identifier | 829592 = Lawson ID"}]},{"description":"PLATE 120DX3.5MM 12MM OFF 3HL","code_information":[{"code":"Sx00-0907-126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877706","type":"LOCAL"},{"code":"876374","type":"LOCAL"}],"standard_charges":[{"gross_charge":7391.6,"discounted_cash":5174.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877706 = Hospital System Supply Identifier | 876374 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 6MM OFF 3HL","code_information":[{"code":"Sx00-0907-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877707","type":"LOCAL"},{"code":"876375","type":"LOCAL"}],"standard_charges":[{"gross_charge":6763.84,"discounted_cash":4734.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877707 = Hospital System Supply Identifier | 876375 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877708","type":"LOCAL"},{"code":"876376","type":"LOCAL"}],"standard_charges":[{"gross_charge":6763.84,"discounted_cash":4734.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877708 = Hospital System Supply Identifier | 876376 = Lawson ID"}]},{"description":"PLATE 100DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877709","type":"LOCAL"},{"code":"876377","type":"LOCAL"}],"standard_charges":[{"gross_charge":7090.35,"discounted_cash":4963.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877709 = Hospital System Supply Identifier | 876377 = Lawson ID"}]},{"description":"PLATE 110DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877710","type":"LOCAL"},{"code":"876378","type":"LOCAL"}],"standard_charges":[{"gross_charge":7090.35,"discounted_cash":4963.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877710 = Hospital System Supply Identifier | 876378 = Lawson ID"}]},{"description":"PLATE 120DX4.5MM 6MM OFF 4HL","code_information":[{"code":"Sx00-0907-136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877711","type":"LOCAL"},{"code":"876379","type":"LOCAL"}],"standard_charges":[{"gross_charge":7090.35,"discounted_cash":4963.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877711 = Hospital System Supply Identifier | 876379 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877713","type":"LOCAL"},{"code":"876381","type":"LOCAL"}],"standard_charges":[{"gross_charge":6906.43,"discounted_cash":4834.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877713 = Hospital System Supply Identifier | 876381 = Lawson ID"}]},{"description":"PLATE 90DX4.5MM 14MM OFF 3HL","code_information":[{"code":"Sx00-0907-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877712","type":"LOCAL"},{"code":"876380","type":"LOCAL"}],"standard_charges":[{"gross_charge":6906.43,"discounted_cash":4834.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877712 = Hospital System Supply Identifier | 876380 = Lawson ID"}]},{"description":"PLATE 100DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877714","type":"LOCAL"},{"code":"876382","type":"LOCAL"}],"standard_charges":[{"gross_charge":7090.35,"discounted_cash":4963.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877714 = Hospital System Supply Identifier | 876382 = Lawson ID"}]},{"description":"PLATE 110DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-144","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877715","type":"LOCAL"},{"code":"876383","type":"LOCAL"}],"standard_charges":[{"gross_charge":7090.35,"discounted_cash":4963.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877715 = Hospital System Supply Identifier | 876383 = Lawson ID"}]},{"description":"PLATE 120DX4.5MM 14MM OFF 4HL","code_information":[{"code":"Sx00-0907-146","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877716","type":"LOCAL"},{"code":"876384","type":"LOCAL"}],"standard_charges":[{"gross_charge":7090.35,"discounted_cash":4963.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877716 = Hospital System Supply Identifier | 876384 = Lawson ID"}]},{"description":"PLATE BONE 3.5 130-DEG 6-HOLE","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934163","type":"LOCAL"},{"code":"784754","type":"LOCAL"}],"standard_charges":[{"gross_charge":7572.55,"discounted_cash":5300.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934163 = Hospital System Supply Identifier | 784754 = Lawson ID"}]},{"description":"PLATE BONE 130 DEG 784H SS","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934162","type":"LOCAL"},{"code":"830396","type":"LOCAL"}],"standard_charges":[{"gross_charge":7391.6,"discounted_cash":5174.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934162 = Hospital System Supply Identifier | 830396 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 3HL","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877717","type":"LOCAL"},{"code":"876385","type":"LOCAL"}],"standard_charges":[{"gross_charge":7185.48,"discounted_cash":5029.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877717 = Hospital System Supply Identifier | 876385 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 8HL","code_information":[{"code":"Sx00-0907-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877718","type":"LOCAL"},{"code":"876386","type":"LOCAL"}],"standard_charges":[{"gross_charge":10372.36,"discounted_cash":7260.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877718 = Hospital System Supply Identifier | 876386 = Lawson ID"}]},{"description":"PLATE 130DX3.5MM 10HL","code_information":[{"code":"Sx00-0907-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877719","type":"LOCAL"},{"code":"876387","type":"LOCAL"}],"standard_charges":[{"gross_charge":10372.36,"discounted_cash":7260.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877719 = Hospital System Supply Identifier | 876387 = Lawson ID"}]},{"description":"PLATE 130DX4.5MM 6HL","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877721","type":"LOCAL"},{"code":"876389","type":"LOCAL"}],"standard_charges":[{"gross_charge":7090.35,"discounted_cash":4963.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877721 = Hospital System Supply Identifier | 876389 = Lawson ID"}]},{"description":"PLATE 130DX4.5MM 3HL","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877720","type":"LOCAL"},{"code":"876388","type":"LOCAL"}],"standard_charges":[{"gross_charge":6763.84,"discounted_cash":4734.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877720 = Hospital System Supply Identifier | 876388 = Lawson ID"}]},{"description":"PLATE BONE FX 4.5 130-DEG 4-HO","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934164","type":"LOCAL"},{"code":"800287","type":"LOCAL"}],"standard_charges":[{"gross_charge":6906.43,"discounted_cash":4834.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934164 = Hospital System Supply Identifier | 800287 = Lawson ID"}]},{"description":"PLATE BONE 130 D FEM PROX 8H L","code_information":[{"code":"Sx00-0907-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934165","type":"LOCAL"},{"code":"824109","type":"LOCAL"}],"standard_charges":[{"gross_charge":10372.36,"discounted_cash":7260.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934165 = Hospital System Supply Identifier | 824109 = Lawson ID"}]},{"description":"PLATE 103DX4.5MM 10HL","code_information":[{"code":"Sx00-0907-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877722","type":"LOCAL"},{"code":"876390","type":"LOCAL"}],"standard_charges":[{"gross_charge":10372.36,"discounted_cash":7260.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877722 = Hospital System Supply Identifier | 876390 = Lawson ID"}]},{"description":"PLATE 150DX3.5MM 3HL","code_information":[{"code":"Sx00-0907-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877723","type":"LOCAL"},{"code":"876391","type":"LOCAL"}],"standard_charges":[{"gross_charge":7185.48,"discounted_cash":5029.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877723 = Hospital System Supply Identifier | 876391 = Lawson ID"}]},{"description":"PLATE 150DX3.5MM 5HL","code_information":[{"code":"Sx00-0907-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877724","type":"LOCAL"},{"code":"876392","type":"LOCAL"}],"standard_charges":[{"gross_charge":7391.6,"discounted_cash":5174.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877724 = Hospital System Supply Identifier | 876392 = Lawson ID"}]},{"description":"PLATE 150DX4.5 3HL","code_information":[{"code":"Sx00-0907-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877725","type":"LOCAL"},{"code":"876393","type":"LOCAL"}],"standard_charges":[{"gross_charge":6575.52,"discounted_cash":4602.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877725 = Hospital System Supply Identifier | 876393 = Lawson ID"}]},{"description":"PLATE 150DX4.5 5HL","code_information":[{"code":"Sx00-0907-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877726","type":"LOCAL"},{"code":"876394","type":"LOCAL"}],"standard_charges":[{"gross_charge":6763.84,"discounted_cash":4734.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877726 = Hospital System Supply Identifier | 876394 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X38MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877730","type":"LOCAL"},{"code":"876398","type":"LOCAL"}],"standard_charges":[{"gross_charge":1919.74,"discounted_cash":1343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877730 = Hospital System Supply Identifier | 876398 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X34MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877729","type":"LOCAL"},{"code":"876397","type":"LOCAL"}],"standard_charges":[{"gross_charge":1919.74,"discounted_cash":1343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877729 = Hospital System Supply Identifier | 876397 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X32MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877728","type":"LOCAL"},{"code":"876396","type":"LOCAL"}],"standard_charges":[{"gross_charge":1919.74,"discounted_cash":1343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877728 = Hospital System Supply Identifier | 876396 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X30MM","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877727","type":"LOCAL"},{"code":"876395","type":"LOCAL"}],"standard_charges":[{"gross_charge":1919.74,"discounted_cash":1343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877727 = Hospital System Supply Identifier | 876395 = Lawson ID"}]},{"description":"SCREW BONE 3.5X36CANN LOCKING","code_information":[{"code":"Sx00-0907-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934166","type":"LOCAL"},{"code":"830394","type":"LOCAL"}],"standard_charges":[{"gross_charge":1919.74,"discounted_cash":1343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934166 = Hospital System Supply Identifier | 830394 = Lawson ID"}]},{"description":"SCREW BONE 3.5X40CANN LOCKING","code_information":[{"code":"Sx00-0907-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934167","type":"LOCAL"},{"code":"830395","type":"LOCAL"}],"standard_charges":[{"gross_charge":1919.74,"discounted_cash":1343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934167 = Hospital System Supply Identifier | 830395 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X45MM","code_information":[{"code":"Sx00-0907-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877731","type":"LOCAL"},{"code":"876399","type":"LOCAL"}],"standard_charges":[{"gross_charge":1919.74,"discounted_cash":1343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877731 = Hospital System Supply Identifier | 876399 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X50MM","code_information":[{"code":"Sx00-0907-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877732","type":"LOCAL"},{"code":"876400","type":"LOCAL"}],"standard_charges":[{"gross_charge":1919.74,"discounted_cash":1343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877732 = Hospital System Supply Identifier | 876400 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X55MM","code_information":[{"code":"Sx00-0907-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877733","type":"LOCAL"},{"code":"876401","type":"LOCAL"}],"standard_charges":[{"gross_charge":1919.74,"discounted_cash":1343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877733 = Hospital System Supply Identifier | 876401 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X60MM","code_information":[{"code":"Sx00-0907-376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877734","type":"LOCAL"},{"code":"876402","type":"LOCAL"}],"standard_charges":[{"gross_charge":1919.74,"discounted_cash":1343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877734 = Hospital System Supply Identifier | 876402 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X65MM","code_information":[{"code":"Sx00-0907-376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877735","type":"LOCAL"},{"code":"876403","type":"LOCAL"}],"standard_charges":[{"gross_charge":1919.74,"discounted_cash":1343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877735 = Hospital System Supply Identifier | 876403 = Lawson ID"}]},{"description":"SCREW LOK CORT CANN 3.5X70MM","code_information":[{"code":"Sx00-0907-377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877736","type":"LOCAL"},{"code":"876404","type":"LOCAL"}],"standard_charges":[{"gross_charge":1919.74,"discounted_cash":1343.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877736 = Hospital System Supply Identifier | 876404 = Lawson ID"}]},{"description":"PLATE 140DX3.5MM","code_information":[{"code":"Sx00-0907-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877737","type":"LOCAL"},{"code":"876405","type":"LOCAL"}],"standard_charges":[{"gross_charge":7717.64,"discounted_cash":5402.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877737 = Hospital System Supply Identifier | 876405 = Lawson ID"}]},{"description":"PLATE BONE 3 HOLE HIP 140 DEGREE 0009074103 3.5MM","code_information":[{"code":"Sx00-0907-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176368","type":"LOCAL"},{"code":"1082505","type":"LOCAL"}],"standard_charges":[{"gross_charge":7302.36,"discounted_cash":5111.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176368 = Hospital System Supply Identifier | 1082505 = Lawson ID"}]},{"description":"PLATE BONE 3 HOLE HIP 140 DEGREE 0009074203 4.5MM","code_information":[{"code":"Sx00-0907-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176370","type":"LOCAL"},{"code":"1082555","type":"LOCAL"}],"standard_charges":[{"gross_charge":7302.36,"discounted_cash":5111.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176370 = Hospital System Supply Identifier | 1082555 = Lawson ID"}]},{"description":"PLATE 140DX4.5MM","code_information":[{"code":"Sx00-0907-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877738","type":"LOCAL"},{"code":"876406","type":"LOCAL"}],"standard_charges":[{"gross_charge":7235.92,"discounted_cash":5065.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877738 = Hospital System Supply Identifier | 876406 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X10MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877739","type":"LOCAL"},{"code":"876407","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877739 = Hospital System Supply Identifier | 876407 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X12MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877740","type":"LOCAL"},{"code":"876408","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877740 = Hospital System Supply Identifier | 876408 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X14MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877741","type":"LOCAL"},{"code":"876409","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877741 = Hospital System Supply Identifier | 876409 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X16MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877742","type":"LOCAL"},{"code":"876410","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877742 = Hospital System Supply Identifier | 876410 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X18MM","code_information":[{"code":"Sx00-0907-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877743","type":"LOCAL"},{"code":"876411","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877743 = Hospital System Supply Identifier | 876411 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X28MM","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877745","type":"LOCAL"},{"code":"876413","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877745 = Hospital System Supply Identifier | 876413 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X26MM","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877744","type":"LOCAL"},{"code":"876412","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877744 = Hospital System Supply Identifier | 876412 = Lawson ID"}]},{"description":"SCREW BONE 4.5X20 CORT NON-LOK","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934168","type":"LOCAL"},{"code":"800290","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934168 = Hospital System Supply Identifier | 800290 = Lawson ID"}]},{"description":"SCREW BONE 4.5X22 CORT NON-LOK","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934169","type":"LOCAL"},{"code":"800289","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934169 = Hospital System Supply Identifier | 800289 = Lawson ID"}]},{"description":"SCREW BONE 24X4.5 SLF-TP CORT","code_information":[{"code":"Sx00-0907-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934170","type":"LOCAL"},{"code":"841869","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934170 = Hospital System Supply Identifier | 841869 = Lawson ID"}]},{"description":"SCREW BONE 384.5LONG BONE CORT","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934172","type":"LOCAL"},{"code":"824112","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934172 = Hospital System Supply Identifier | 824112 = Lawson ID"}]},{"description":"SCREW BONE 364.5LONG BONE CORT","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934171","type":"LOCAL"},{"code":"824113","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934171 = Hospital System Supply Identifier | 824113 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X30MM","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877746","type":"LOCAL"},{"code":"876414","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877746 = Hospital System Supply Identifier | 876414 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X32MM","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877747","type":"LOCAL"},{"code":"876415","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877747 = Hospital System Supply Identifier | 876415 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X34MM","code_information":[{"code":"Sx00-0907-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877748","type":"LOCAL"},{"code":"876416","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877748 = Hospital System Supply Identifier | 876416 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X44MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877751","type":"LOCAL"},{"code":"876419","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877751 = Hospital System Supply Identifier | 876419 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X40MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877749","type":"LOCAL"},{"code":"876417","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877749 = Hospital System Supply Identifier | 876417 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X42MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877750","type":"LOCAL"},{"code":"876418","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877750 = Hospital System Supply Identifier | 876418 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X46MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877752","type":"LOCAL"},{"code":"876420","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877752 = Hospital System Supply Identifier | 876420 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X48MM","code_information":[{"code":"Sx00-0907-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877753","type":"LOCAL"},{"code":"876421","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877753 = Hospital System Supply Identifier | 876421 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X50MM","code_information":[{"code":"Sx00-0907-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877754","type":"LOCAL"},{"code":"876422","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877754 = Hospital System Supply Identifier | 876422 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X55MM","code_information":[{"code":"Sx00-0907-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877755","type":"LOCAL"},{"code":"876423","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877755 = Hospital System Supply Identifier | 876423 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X60MM","code_information":[{"code":"Sx00-0907-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877756","type":"LOCAL"},{"code":"876424","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877756 = Hospital System Supply Identifier | 876424 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X65MM","code_information":[{"code":"Sx00-0907-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877757","type":"LOCAL"},{"code":"876425","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877757 = Hospital System Supply Identifier | 876425 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X75MM","code_information":[{"code":"Sx00-0907-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877759","type":"LOCAL"},{"code":"876427","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877759 = Hospital System Supply Identifier | 876427 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X70MM","code_information":[{"code":"Sx00-0907-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877758","type":"LOCAL"},{"code":"876426","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877758 = Hospital System Supply Identifier | 876426 = Lawson ID"}]},{"description":"SCREW N-LOK CORT F/T 4.5X80MM","code_information":[{"code":"Sx00-0907-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877760","type":"LOCAL"},{"code":"876428","type":"LOCAL"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":266.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877760 = Hospital System Supply Identifier | 876428 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X18","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877765","type":"LOCAL"},{"code":"876433","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877765 = Hospital System Supply Identifier | 876433 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X16","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877764","type":"LOCAL"},{"code":"876432","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877764 = Hospital System Supply Identifier | 876432 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X10","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877761","type":"LOCAL"},{"code":"876429","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877761 = Hospital System Supply Identifier | 876429 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X12","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877762","type":"LOCAL"},{"code":"876430","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877762 = Hospital System Supply Identifier | 876430 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X14","code_information":[{"code":"Sx00-0907-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877763","type":"LOCAL"},{"code":"876431","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877763 = Hospital System Supply Identifier | 876431 = Lawson ID"}]},{"description":"SCREW BONE 20X4.5 CORT","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934173","type":"LOCAL"},{"code":"841867","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934173 = Hospital System Supply Identifier | 841867 = Lawson ID"}]},{"description":"SCREW BONE 24X4.5 CORT","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934174","type":"LOCAL"},{"code":"841868","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934174 = Hospital System Supply Identifier | 841868 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X22","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877766","type":"LOCAL"},{"code":"876434","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877766 = Hospital System Supply Identifier | 876434 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X26","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877767","type":"LOCAL"},{"code":"876435","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877767 = Hospital System Supply Identifier | 876435 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X28","code_information":[{"code":"Sx00-0907-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877768","type":"LOCAL"},{"code":"876436","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877768 = Hospital System Supply Identifier | 876436 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X36","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877772","type":"LOCAL"},{"code":"876440","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877772 = Hospital System Supply Identifier | 876440 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X34","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877771","type":"LOCAL"},{"code":"876439","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877771 = Hospital System Supply Identifier | 876439 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X38","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877773","type":"LOCAL"},{"code":"876441","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877773 = Hospital System Supply Identifier | 876441 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X30","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877769","type":"LOCAL"},{"code":"876437","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877769 = Hospital System Supply Identifier | 876437 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X32","code_information":[{"code":"Sx00-0907-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877770","type":"LOCAL"},{"code":"876438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877770 = Hospital System Supply Identifier | 876438 = Lawson ID"}]},{"description":"SCREW BONE 42X4.5 CORT","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934175","type":"LOCAL"},{"code":"841870","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934175 = Hospital System Supply Identifier | 841870 = Lawson ID"}]},{"description":"SCREW BONE 46X4.5 CORT","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934176","type":"LOCAL"},{"code":"841871","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934176 = Hospital System Supply Identifier | 841871 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X40","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877774","type":"LOCAL"},{"code":"876442","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877774 = Hospital System Supply Identifier | 876442 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X44","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877775","type":"LOCAL"},{"code":"876443","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877775 = Hospital System Supply Identifier | 876443 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X45","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877776","type":"LOCAL"},{"code":"876444","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877776 = Hospital System Supply Identifier | 876444 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X48","code_information":[{"code":"Sx00-0907-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877777","type":"LOCAL"},{"code":"876445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877777 = Hospital System Supply Identifier | 876445 = Lawson ID"}]},{"description":"SCREW BONE 55X4.5 CORT","code_information":[{"code":"Sx00-0907-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934178","type":"LOCAL"},{"code":"841873","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934178 = Hospital System Supply Identifier | 841873 = Lawson ID"}]},{"description":"SCREW BONE 50X4.5 CORT","code_information":[{"code":"Sx00-0907-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934177","type":"LOCAL"},{"code":"841872","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934177 = Hospital System Supply Identifier | 841872 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X65","code_information":[{"code":"Sx00-0907-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877779","type":"LOCAL"},{"code":"876447","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877779 = Hospital System Supply Identifier | 876447 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X60","code_information":[{"code":"Sx00-0907-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877778","type":"LOCAL"},{"code":"876446","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877778 = Hospital System Supply Identifier | 876446 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X70","code_information":[{"code":"Sx00-0907-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877780","type":"LOCAL"},{"code":"876448","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877780 = Hospital System Supply Identifier | 876448 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X75","code_information":[{"code":"Sx00-0907-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877781","type":"LOCAL"},{"code":"876449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877781 = Hospital System Supply Identifier | 876449 = Lawson ID"}]},{"description":"SCREW LOK CORT F/T HEX 4.5X80","code_information":[{"code":"Sx00-0907-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877782","type":"LOCAL"},{"code":"876450","type":"LOCAL"}],"standard_charges":[{"gross_charge":1232.98,"discounted_cash":863.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877782 = Hospital System Supply Identifier | 876450 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X30MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877783","type":"LOCAL"},{"code":"876451","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877783 = Hospital System Supply Identifier | 876451 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X32MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877784","type":"LOCAL"},{"code":"876452","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877784 = Hospital System Supply Identifier | 876452 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X34MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877785","type":"LOCAL"},{"code":"876453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877785 = Hospital System Supply Identifier | 876453 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X36MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877786","type":"LOCAL"},{"code":"876454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877786 = Hospital System Supply Identifier | 876454 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X38MM","code_information":[{"code":"Sx00-0907-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877787","type":"LOCAL"},{"code":"876455","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877787 = Hospital System Supply Identifier | 876455 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X45MM","code_information":[{"code":"Sx00-0907-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877789","type":"LOCAL"},{"code":"876457","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877789 = Hospital System Supply Identifier | 876457 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X40MM","code_information":[{"code":"Sx00-0907-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877788","type":"LOCAL"},{"code":"876456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877788 = Hospital System Supply Identifier | 876456 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X50MM","code_information":[{"code":"Sx00-0907-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877790","type":"LOCAL"},{"code":"876458","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877790 = Hospital System Supply Identifier | 876458 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X55MM","code_information":[{"code":"Sx00-0907-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877791","type":"LOCAL"},{"code":"876459","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877791 = Hospital System Supply Identifier | 876459 = Lawson ID"}]},{"description":"SCREW BONE 654.5PROX FEM T20 H","code_information":[{"code":"Sx00-0907-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934179","type":"LOCAL"},{"code":"824111","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934179 = Hospital System Supply Identifier | 824111 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X60MM","code_information":[{"code":"Sx00-0907-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877792","type":"LOCAL"},{"code":"876460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877792 = Hospital System Supply Identifier | 876460 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X70MM","code_information":[{"code":"Sx00-0907-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877793","type":"LOCAL"},{"code":"876461","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877793 = Hospital System Supply Identifier | 876461 = Lawson ID"}]},{"description":"SCREW CANN CORT LOK 4.5X75MM","code_information":[{"code":"Sx00-0907-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877794","type":"LOCAL"},{"code":"876462","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877794 = Hospital System Supply Identifier | 876462 = Lawson ID"}]},{"description":"SCREW BONE 804.5HEXALOBE FEM P","code_information":[{"code":"Sx00-0907-478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934180","type":"LOCAL"},{"code":"824110","type":"LOCAL"}],"standard_charges":[{"gross_charge":1791.24,"discounted_cash":1253.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934180 = Hospital System Supply Identifier | 824110 = Lawson ID"}]},{"description":"DISC - GWIRE RM MDLLRY4.7X68","code_information":[{"code":"Sx00-0928-039","type":"CDM"},{"code":"272","type":"RC"},{"code":"26955","type":"LOCAL"},{"code":"310986","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 26955 = Hospital System Supply Identifier | 310986 = Lawson ID"}]},{"description":"MESH L1 STD ORTHOG STRIP 117MM","code_information":[{"code":"Sx00-100-63-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"743219","type":"LOCAL"},{"code":"773376","type":"LOCAL"}],"standard_charges":[{"gross_charge":1382.36,"discounted_cash":967.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 743219 = Hospital System Supply Identifier | 773376 = Lawson ID"}]},{"description":"NAIL FLEX TI 1.5MM","code_information":[{"code":"Sx00-1000-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877795","type":"LOCAL"},{"code":"876463","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877795 = Hospital System Supply Identifier | 876463 = Lawson ID"}]},{"description":"NAIL FLEX TI 2.0MM","code_information":[{"code":"Sx00-1000-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877796","type":"LOCAL"},{"code":"876464","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877796 = Hospital System Supply Identifier | 876464 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY 2.5TI FLEX","code_information":[{"code":"Sx00-1000-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934208","type":"LOCAL"},{"code":"816512","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934208 = Hospital System Supply Identifier | 816512 = Lawson ID"}]},{"description":"NAIL FLEX TI 3.0MM","code_information":[{"code":"Sx00-1000-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877797","type":"LOCAL"},{"code":"876465","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877797 = Hospital System Supply Identifier | 876465 = Lawson ID"}]},{"description":"NAIL FLEX TI 3.5MM","code_information":[{"code":"Sx00-1000-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877798","type":"LOCAL"},{"code":"876466","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877798 = Hospital System Supply Identifier | 876466 = Lawson ID"}]},{"description":"NAIL FLEX TI 4.0MM","code_information":[{"code":"Sx00-1000-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877799","type":"LOCAL"},{"code":"876467","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877799 = Hospital System Supply Identifier | 876467 = Lawson ID"}]},{"description":"NAIL FLEX TI 4.5MM","code_information":[{"code":"Sx00-1000-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877800","type":"LOCAL"},{"code":"876468","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877800 = Hospital System Supply Identifier | 876468 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 2MM","code_information":[{"code":"Sx00-1000-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585491","type":"LOCAL"},{"code":"401794","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.17,"discounted_cash":632.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585491 = Hospital System Supply Identifier | 401794 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 2.5MM","code_information":[{"code":"Sx00-1000-125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585492","type":"LOCAL"},{"code":"401795","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.17,"discounted_cash":632.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585492 = Hospital System Supply Identifier | 401795 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 3MM","code_information":[{"code":"Sx00-1000-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585493","type":"LOCAL"},{"code":"401796","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.17,"discounted_cash":632.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585493 = Hospital System Supply Identifier | 401796 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 3.5MM","code_information":[{"code":"Sx00-1000-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585494","type":"LOCAL"},{"code":"401797","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.17,"discounted_cash":632.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585494 = Hospital System Supply Identifier | 401797 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 4MM","code_information":[{"code":"Sx00-1000-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934209","type":"LOCAL"},{"code":"401798","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.17,"discounted_cash":632.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934209 = Hospital System Supply Identifier | 401798 = Lawson ID"}]},{"description":"CAP NAIL PEDFLEX 4.5MM","code_information":[{"code":"Sx00-1000-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934210","type":"LOCAL"},{"code":"401799","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.17,"discounted_cash":632.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934210 = Hospital System Supply Identifier | 401799 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 1.5MM","code_information":[{"code":"Sx00-1000-315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934211","type":"LOCAL"},{"code":"401800","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934211 = Hospital System Supply Identifier | 401800 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 2MM","code_information":[{"code":"Sx00-1000-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934212","type":"LOCAL"},{"code":"401801","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934212 = Hospital System Supply Identifier | 401801 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 2.5MM","code_information":[{"code":"Sx00-1000-325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934213","type":"LOCAL"},{"code":"401802","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934213 = Hospital System Supply Identifier | 401802 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3MM","code_information":[{"code":"Sx00-1000-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934214","type":"LOCAL"},{"code":"401803","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934214 = Hospital System Supply Identifier | 401803 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3.5MM","code_information":[{"code":"Sx00-1000-335","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934215","type":"LOCAL"},{"code":"401804","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934215 = Hospital System Supply Identifier | 401804 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 4MM","code_information":[{"code":"Sx00-1000-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934216","type":"LOCAL"},{"code":"401805","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934216 = Hospital System Supply Identifier | 401805 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 1.5MM","code_information":[{"code":"Sx00-1000-515","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585486","type":"LOCAL"},{"code":"401787","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585486 = Hospital System Supply Identifier | 401787 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 2MM","code_information":[{"code":"Sx00-1000-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585487","type":"LOCAL"},{"code":"401788","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585487 = Hospital System Supply Identifier | 401788 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 2.5MM","code_information":[{"code":"Sx00-1000-525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585488","type":"LOCAL"},{"code":"401789","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585488 = Hospital System Supply Identifier | 401789 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 3MM","code_information":[{"code":"Sx00-1000-530","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585489","type":"LOCAL"},{"code":"401790","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585489 = Hospital System Supply Identifier | 401790 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 3.5MM","code_information":[{"code":"Sx00-1000-535","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585490","type":"LOCAL"},{"code":"401791","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585490 = Hospital System Supply Identifier | 401791 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 4MM","code_information":[{"code":"Sx00-1000-540","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934217","type":"LOCAL"},{"code":"401792","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934217 = Hospital System Supply Identifier | 401792 = Lawson ID"}]},{"description":"NAIL PEDFLEX TI 4.5MM","code_information":[{"code":"Sx00-1000-545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934218","type":"LOCAL"},{"code":"401793","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934218 = Hospital System Supply Identifier | 401793 = Lawson ID"}]},{"description":"NAIL FLEX SS RND TIP 1.5X300MM","code_information":[{"code":"Sx00-1000-615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"591529","type":"LOCAL"},{"code":"454543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 591529 = Hospital System Supply Identifier | 454543 = Lawson ID"}]},{"description":"NAIL PEDIFLEX RND TIP SS 2.0MM","code_information":[{"code":"Sx00-1000-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"591418","type":"LOCAL"},{"code":"449446","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 591418 = Hospital System Supply Identifier | 449446 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 2.5X300MM","code_information":[{"code":"Sx00-1000-625","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"591599","type":"LOCAL"},{"code":"455417","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 591599 = Hospital System Supply Identifier | 455417 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3.0X400MM","code_information":[{"code":"Sx00-1000-630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"591600","type":"LOCAL"},{"code":"455418","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 591600 = Hospital System Supply Identifier | 455418 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 3.5X400MM","code_information":[{"code":"Sx00-1000-635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"591601","type":"LOCAL"},{"code":"455419","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 591601 = Hospital System Supply Identifier | 455419 = Lawson ID"}]},{"description":"NAIL PEDFLEX SS 4.0X450MM","code_information":[{"code":"Sx00-1000-640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"591602","type":"LOCAL"},{"code":"455420","type":"LOCAL"}],"standard_charges":[{"gross_charge":1706.72,"discounted_cash":1194.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 591602 = Hospital System Supply Identifier | 455420 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 1.5X300","code_information":[{"code":"Sx00-1001-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877801","type":"LOCAL"},{"code":"876469","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877801 = Hospital System Supply Identifier | 876469 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 2.0X300","code_information":[{"code":"Sx00-1001-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877802","type":"LOCAL"},{"code":"876470","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877802 = Hospital System Supply Identifier | 876470 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 2.5X300","code_information":[{"code":"Sx00-1001-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877803","type":"LOCAL"},{"code":"876471","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877803 = Hospital System Supply Identifier | 876471 = Lawson ID"}]},{"description":"NAIL TI 3.0MMX400FLEX","code_information":[{"code":"Sx00-1001-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934220","type":"LOCAL"},{"code":"827479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934220 = Hospital System Supply Identifier | 827479 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 3.5X400","code_information":[{"code":"Sx00-1001-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877804","type":"LOCAL"},{"code":"876472","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877804 = Hospital System Supply Identifier | 876472 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP SS 4.0X450","code_information":[{"code":"Sx00-1001-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877805","type":"LOCAL"},{"code":"876473","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877805 = Hospital System Supply Identifier | 876473 = Lawson ID"}]},{"description":"NAIL TI FLEX 1.5MMX300MM","code_information":[{"code":"Sx00-1001-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934221","type":"LOCAL"},{"code":"827565","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934221 = Hospital System Supply Identifier | 827565 = Lawson ID"}]},{"description":"NAIL TI FLEX 2.0MMX300MM","code_information":[{"code":"Sx00-1001-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934222","type":"LOCAL"},{"code":"827470","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934222 = Hospital System Supply Identifier | 827470 = Lawson ID"}]},{"description":"NAIL TI FLEX 2.5MMX300MM","code_information":[{"code":"Sx00-1001-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934223","type":"LOCAL"},{"code":"827469","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934223 = Hospital System Supply Identifier | 827469 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY 4003.5ELAS","code_information":[{"code":"Sx00-1001-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934225","type":"LOCAL"},{"code":"829177","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934225 = Hospital System Supply Identifier | 829177 = Lawson ID"}]},{"description":"NAIL TI FLEX 3.0MMX400ROUND TI","code_information":[{"code":"Sx00-1001-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934224","type":"LOCAL"},{"code":"829382","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934224 = Hospital System Supply Identifier | 829382 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP TI 4.0X450","code_information":[{"code":"Sx00-1001-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877806","type":"LOCAL"},{"code":"876474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877806 = Hospital System Supply Identifier | 876474 = Lawson ID"}]},{"description":"NAIL PEDFLX RND TIP TI 4.5X450","code_information":[{"code":"Sx00-1001-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877807","type":"LOCAL"},{"code":"876475","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877807 = Hospital System Supply Identifier | 876475 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176252","type":"LOCAL"},{"code":"1083729","type":"LOCAL"}],"standard_charges":[{"gross_charge":2673.22,"discounted_cash":1871.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176252 = Hospital System Supply Identifier | 1083729 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175859","type":"LOCAL"},{"code":"1083742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2673.22,"discounted_cash":1871.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175859 = Hospital System Supply Identifier | 1083742 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175924","type":"LOCAL"},{"code":"1083545","type":"LOCAL"}],"standard_charges":[{"gross_charge":2673.22,"discounted_cash":1871.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175924 = Hospital System Supply Identifier | 1083545 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175811","type":"LOCAL"},{"code":"1083589","type":"LOCAL"}],"standard_charges":[{"gross_charge":2673.22,"discounted_cash":1871.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175811 = Hospital System Supply Identifier | 1083589 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175820","type":"LOCAL"},{"code":"1083558","type":"LOCAL"}],"standard_charges":[{"gross_charge":2673.22,"discounted_cash":1871.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175820 = Hospital System Supply Identifier | 1083558 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175779","type":"LOCAL"},{"code":"1083620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2673.22,"discounted_cash":1871.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175779 = Hospital System Supply Identifier | 1083620 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176396","type":"LOCAL"},{"code":"1083593","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.6,"discounted_cash":728.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176396 = Hospital System Supply Identifier | 1083593 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176051","type":"LOCAL"},{"code":"1083599","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.6,"discounted_cash":728.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176051 = Hospital System Supply Identifier | 1083599 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED STAINLESS-STEEL LONG-BONE","code_information":[{"code":"Sx00-1001-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176375","type":"LOCAL"},{"code":"1083628","type":"LOCAL"}],"standard_charges":[{"gross_charge":1040.6,"discounted_cash":728.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176375 = Hospital System Supply Identifier | 1083628 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176178","type":"LOCAL"},{"code":"1083689","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.8,"discounted_cash":770.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176178 = Hospital System Supply Identifier | 1083689 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176544","type":"LOCAL"},{"code":"1083559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.8,"discounted_cash":770.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176544 = Hospital System Supply Identifier | 1083559 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175810","type":"LOCAL"},{"code":"1083659","type":"LOCAL"}],"standard_charges":[{"gross_charge":1100.8,"discounted_cash":770.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175810 = Hospital System Supply Identifier | 1083659 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175860","type":"LOCAL"},{"code":"1083733","type":"LOCAL"}],"standard_charges":[{"gross_charge":2810.39,"discounted_cash":1967.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175860 = Hospital System Supply Identifier | 1083733 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176377","type":"LOCAL"},{"code":"1083716","type":"LOCAL"}],"standard_charges":[{"gross_charge":2810.39,"discounted_cash":1967.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176377 = Hospital System Supply Identifier | 1083716 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176554","type":"LOCAL"},{"code":"1083616","type":"LOCAL"}],"standard_charges":[{"gross_charge":2810.39,"discounted_cash":1967.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176554 = Hospital System Supply Identifier | 1083616 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176263","type":"LOCAL"},{"code":"1083710","type":"LOCAL"}],"standard_charges":[{"gross_charge":2810.39,"discounted_cash":1967.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176263 = Hospital System Supply Identifier | 1083710 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175789","type":"LOCAL"},{"code":"1083635","type":"LOCAL"}],"standard_charges":[{"gross_charge":2810.39,"discounted_cash":1967.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175789 = Hospital System Supply Identifier | 1083635 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175796","type":"LOCAL"},{"code":"1083707","type":"LOCAL"}],"standard_charges":[{"gross_charge":2810.39,"discounted_cash":1967.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175796 = Hospital System Supply Identifier | 1083707 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176497","type":"LOCAL"},{"code":"1083723","type":"LOCAL"}],"standard_charges":[{"gross_charge":2810.39,"discounted_cash":1967.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176497 = Hospital System Supply Identifier | 1083723 = Lawson ID"}]},{"description":"SCREW-BONE INTRAMEDULLARY-NAIL CANNULATED TITANIUM LONG-BONE","code_information":[{"code":"Sx00-1001-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175886","type":"LOCAL"},{"code":"1083736","type":"LOCAL"}],"standard_charges":[{"gross_charge":2810.39,"discounted_cash":1967.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175886 = Hospital System Supply Identifier | 1083736 = Lawson ID"}]},{"description":"GUIDE WIRE 1.6MMX150SMOOTH","code_information":[{"code":"Sx00-1005-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"},{"code":"934226","type":"LOCAL"},{"code":"827218","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.3,"discounted_cash":235.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934226 = Hospital System Supply Identifier | 827218 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 8HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877812","type":"LOCAL"},{"code":"876480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1238.05,"discounted_cash":866.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877812 = Hospital System Supply Identifier | 876480 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 7HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877811","type":"LOCAL"},{"code":"876479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1238.05,"discounted_cash":866.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877811 = Hospital System Supply Identifier | 876479 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 4HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877809","type":"LOCAL"},{"code":"876477","type":"LOCAL"}],"standard_charges":[{"gross_charge":1126.42,"discounted_cash":788.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877809 = Hospital System Supply Identifier | 876477 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 6HL","code_information":[{"code":"Sx00-1005-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877810","type":"LOCAL"},{"code":"876478","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.24,"discounted_cash":827.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877810 = Hospital System Supply Identifier | 876478 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/4 2.7MM 10HL","code_information":[{"code":"Sx00-1005-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877813","type":"LOCAL"},{"code":"876481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1336.22,"discounted_cash":935.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877813 = Hospital System Supply Identifier | 876481 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 4HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877814","type":"LOCAL"},{"code":"876482","type":"LOCAL"}],"standard_charges":[{"gross_charge":2247.31,"discounted_cash":1573.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877814 = Hospital System Supply Identifier | 876482 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 5HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877815","type":"LOCAL"},{"code":"876483","type":"LOCAL"}],"standard_charges":[{"gross_charge":2289.49,"discounted_cash":1602.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877815 = Hospital System Supply Identifier | 876483 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 6HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877816","type":"LOCAL"},{"code":"876484","type":"LOCAL"}],"standard_charges":[{"gross_charge":2331.68,"discounted_cash":1632.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877816 = Hospital System Supply Identifier | 876484 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 7HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877817","type":"LOCAL"},{"code":"876485","type":"LOCAL"}],"standard_charges":[{"gross_charge":2373.86,"discounted_cash":1661.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877817 = Hospital System Supply Identifier | 876485 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 8HL","code_information":[{"code":"Sx00-1005-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877818","type":"LOCAL"},{"code":"876486","type":"LOCAL"}],"standard_charges":[{"gross_charge":2373.86,"discounted_cash":1661.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877818 = Hospital System Supply Identifier | 876486 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE COMPRESSION LOCKING 12-HOLE","code_information":[{"code":"Sx00-1005-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176611","type":"LOCAL"},{"code":"1083724","type":"LOCAL"}],"standard_charges":[{"gross_charge":2663.65,"discounted_cash":1864.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176611 = Hospital System Supply Identifier | 1083724 = Lawson ID"}]},{"description":"PLATE LOK COMP 2.7MM 10HL","code_information":[{"code":"Sx00-1005-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877819","type":"LOCAL"},{"code":"876487","type":"LOCAL"}],"standard_charges":[{"gross_charge":2456.18,"discounted_cash":1719.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877819 = Hospital System Supply Identifier | 876487 = Lawson ID"}]},{"description":"PLATE RECONSTRUCTION 2.7MM 4HL","code_information":[{"code":"Sx00-1005-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877820","type":"LOCAL"},{"code":"876488","type":"LOCAL"}],"standard_charges":[{"gross_charge":1682.2,"discounted_cash":1177.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877820 = Hospital System Supply Identifier | 876488 = Lawson ID"}]},{"description":"PLATE RECONSTRUCTION 2.7MM 8HL","code_information":[{"code":"Sx00-1005-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877821","type":"LOCAL"},{"code":"876489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1744.51,"discounted_cash":1221.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877821 = Hospital System Supply Identifier | 876489 = Lawson ID"}]},{"description":"PLATE RECONSTRUCTION 2.7MM 12H","code_information":[{"code":"Sx00-1005-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877823","type":"LOCAL"},{"code":"876490","type":"LOCAL"}],"standard_charges":[{"gross_charge":2470.58,"discounted_cash":1729.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877823 = Hospital System Supply Identifier | 876490 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X8MM","code_information":[{"code":"Sx00-1005-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877824","type":"LOCAL"},{"code":"876491","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877824 = Hospital System Supply Identifier | 876491 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X10MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877825","type":"LOCAL"},{"code":"876492","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877825 = Hospital System Supply Identifier | 876492 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X12MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877826","type":"LOCAL"},{"code":"876493","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877826 = Hospital System Supply Identifier | 876493 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X14MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877827","type":"LOCAL"},{"code":"876494","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877827 = Hospital System Supply Identifier | 876494 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X16MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877828","type":"LOCAL"},{"code":"876495","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877828 = Hospital System Supply Identifier | 876495 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X18MM","code_information":[{"code":"Sx00-1005-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877829","type":"LOCAL"},{"code":"876496","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877829 = Hospital System Supply Identifier | 876496 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X26MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877833","type":"LOCAL"},{"code":"876500","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877833 = Hospital System Supply Identifier | 876500 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X24MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877832","type":"LOCAL"},{"code":"876499","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877832 = Hospital System Supply Identifier | 876499 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X28MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877834","type":"LOCAL"},{"code":"876501","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877834 = Hospital System Supply Identifier | 876501 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X20MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877830","type":"LOCAL"},{"code":"876497","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877830 = Hospital System Supply Identifier | 876497 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X22MM","code_information":[{"code":"Sx00-1005-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877831","type":"LOCAL"},{"code":"876498","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877831 = Hospital System Supply Identifier | 876498 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X30MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877835","type":"LOCAL"},{"code":"876502","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877835 = Hospital System Supply Identifier | 876502 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X32MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877836","type":"LOCAL"},{"code":"876503","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877836 = Hospital System Supply Identifier | 876503 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X34MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877837","type":"LOCAL"},{"code":"876504","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877837 = Hospital System Supply Identifier | 876504 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X36MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877838","type":"LOCAL"},{"code":"876505","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877838 = Hospital System Supply Identifier | 876505 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X38MM","code_information":[{"code":"Sx00-1005-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877839","type":"LOCAL"},{"code":"876506","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877839 = Hospital System Supply Identifier | 876506 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X40MM","code_information":[{"code":"Sx00-1005-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877840","type":"LOCAL"},{"code":"876507","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877840 = Hospital System Supply Identifier | 876507 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X45MM","code_information":[{"code":"Sx00-1005-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877841","type":"LOCAL"},{"code":"876508","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877841 = Hospital System Supply Identifier | 876508 = Lawson ID"}]},{"description":"SCREW CORT T10 2.7X50MM","code_information":[{"code":"Sx00-1005-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877842","type":"LOCAL"},{"code":"876509","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.9,"discounted_cash":210.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877842 = Hospital System Supply Identifier | 876509 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X8MM","code_information":[{"code":"Sx00-1005-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877843","type":"LOCAL"},{"code":"876510","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877843 = Hospital System Supply Identifier | 876510 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X18MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877848","type":"LOCAL"},{"code":"876515","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877848 = Hospital System Supply Identifier | 876515 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X16MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877847","type":"LOCAL"},{"code":"876514","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877847 = Hospital System Supply Identifier | 876514 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X10MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877844","type":"LOCAL"},{"code":"876511","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877844 = Hospital System Supply Identifier | 876511 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X12MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877845","type":"LOCAL"},{"code":"876512","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877845 = Hospital System Supply Identifier | 876512 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X14MM","code_information":[{"code":"Sx00-1005-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877846","type":"LOCAL"},{"code":"876513","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877846 = Hospital System Supply Identifier | 876513 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X20MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877849","type":"LOCAL"},{"code":"876516","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877849 = Hospital System Supply Identifier | 876516 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X22MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877850","type":"LOCAL"},{"code":"876517","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877850 = Hospital System Supply Identifier | 876517 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X24MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877851","type":"LOCAL"},{"code":"876518","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877851 = Hospital System Supply Identifier | 876518 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X26MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877852","type":"LOCAL"},{"code":"876519","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877852 = Hospital System Supply Identifier | 876519 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X28MM","code_information":[{"code":"Sx00-1005-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877853","type":"LOCAL"},{"code":"876520","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877853 = Hospital System Supply Identifier | 876520 = Lawson ID"}]},{"description":"SCREW LOK T10 2.7X30MM","code_information":[{"code":"Sx00-1005-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877854","type":"LOCAL"},{"code":"876521","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877854 = Hospital System Supply Identifier | 876521 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 9HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877859","type":"LOCAL"},{"code":"876526","type":"LOCAL"}],"standard_charges":[{"gross_charge":1473.69,"discounted_cash":1031.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877859 = Hospital System Supply Identifier | 876526 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 8HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877858","type":"LOCAL"},{"code":"876525","type":"LOCAL"}],"standard_charges":[{"gross_charge":1405.49,"discounted_cash":983.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877858 = Hospital System Supply Identifier | 876525 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 7HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877857","type":"LOCAL"},{"code":"876524","type":"LOCAL"}],"standard_charges":[{"gross_charge":1405.49,"discounted_cash":983.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877857 = Hospital System Supply Identifier | 876524 = Lawson ID"}]},{"description":"PLATE BONE 1/3 TUBULAR NSTRL 5","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934227","type":"LOCAL"},{"code":"827489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1349.68,"discounted_cash":944.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934227 = Hospital System Supply Identifier | 827489 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 4HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877855","type":"LOCAL"},{"code":"876522","type":"LOCAL"}],"standard_charges":[{"gross_charge":1293.87,"discounted_cash":905.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877855 = Hospital System Supply Identifier | 876522 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 6HL","code_information":[{"code":"Sx00-1005-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877856","type":"LOCAL"},{"code":"876523","type":"LOCAL"}],"standard_charges":[{"gross_charge":1349.68,"discounted_cash":944.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877856 = Hospital System Supply Identifier | 876523 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 10HL","code_information":[{"code":"Sx00-1005-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877860","type":"LOCAL"},{"code":"876527","type":"LOCAL"}],"standard_charges":[{"gross_charge":1281.91,"discounted_cash":897.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877860 = Hospital System Supply Identifier | 876527 = Lawson ID"}]},{"description":"PLATE TUBULAR 1/3 2.7MM 12HL","code_information":[{"code":"Sx00-1005-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877861","type":"LOCAL"},{"code":"876528","type":"LOCAL"}],"standard_charges":[{"gross_charge":1290.61,"discounted_cash":903.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877861 = Hospital System Supply Identifier | 876528 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 8HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877866","type":"LOCAL"},{"code":"876533","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.34,"discounted_cash":1251.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877866 = Hospital System Supply Identifier | 876533 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 7HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877865","type":"LOCAL"},{"code":"876532","type":"LOCAL"}],"standard_charges":[{"gross_charge":1787.34,"discounted_cash":1251.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877865 = Hospital System Supply Identifier | 876532 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 5HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877863","type":"LOCAL"},{"code":"876530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1658.84,"discounted_cash":1161.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877863 = Hospital System Supply Identifier | 876530 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 4HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877862","type":"LOCAL"},{"code":"876529","type":"LOCAL"}],"standard_charges":[{"gross_charge":1660.21,"discounted_cash":1162.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877862 = Hospital System Supply Identifier | 876529 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 6HL","code_information":[{"code":"Sx00-1005-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877864","type":"LOCAL"},{"code":"876531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1721.14,"discounted_cash":1204.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877864 = Hospital System Supply Identifier | 876531 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 10HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877867","type":"LOCAL"},{"code":"876534","type":"LOCAL"}],"standard_charges":[{"gross_charge":1849.65,"discounted_cash":1294.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877867 = Hospital System Supply Identifier | 876534 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 12HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877868","type":"LOCAL"},{"code":"876535","type":"LOCAL"}],"standard_charges":[{"gross_charge":2031.84,"discounted_cash":1422.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877868 = Hospital System Supply Identifier | 876535 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 16HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877869","type":"LOCAL"},{"code":"876536","type":"LOCAL"}],"standard_charges":[{"gross_charge":2031.84,"discounted_cash":1422.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877869 = Hospital System Supply Identifier | 876536 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 18HL","code_information":[{"code":"Sx00-1005-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877870","type":"LOCAL"},{"code":"876537","type":"LOCAL"}],"standard_charges":[{"gross_charge":2129.33,"discounted_cash":1490.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877870 = Hospital System Supply Identifier | 876537 = Lawson ID"}]},{"description":"PLATE COMP LOK 3.5MM 20HL","code_information":[{"code":"Sx00-1005-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877871","type":"LOCAL"},{"code":"876538","type":"LOCAL"}],"standard_charges":[{"gross_charge":2129.33,"discounted_cash":1490.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877871 = Hospital System Supply Identifier | 876538 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 8 HOLE","code_information":[{"code":"Sx00-1005-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877874","type":"LOCAL"},{"code":"876541","type":"LOCAL"}],"standard_charges":[{"gross_charge":2913.49,"discounted_cash":2039.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877874 = Hospital System Supply Identifier | 876541 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 6 HOLE","code_information":[{"code":"Sx00-1005-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877873","type":"LOCAL"},{"code":"876540","type":"LOCAL"}],"standard_charges":[{"gross_charge":2657.52,"discounted_cash":1860.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877873 = Hospital System Supply Identifier | 876540 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 4 HOLE","code_information":[{"code":"Sx00-1005-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877872","type":"LOCAL"},{"code":"876539","type":"LOCAL"}],"standard_charges":[{"gross_charge":2412.21,"discounted_cash":1688.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877872 = Hospital System Supply Identifier | 876539 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 16 HOLE","code_information":[{"code":"Sx00-1005-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877875","type":"LOCAL"},{"code":"876542","type":"LOCAL"}],"standard_charges":[{"gross_charge":3174.05,"discounted_cash":2221.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877875 = Hospital System Supply Identifier | 876542 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 2 HL HD 3HL","code_information":[{"code":"Sx00-1005-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877876","type":"LOCAL"},{"code":"876543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1826.28,"discounted_cash":1278.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877876 = Hospital System Supply Identifier | 876543 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 2 HL HD 5HL","code_information":[{"code":"Sx00-1005-330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877877","type":"LOCAL"},{"code":"876544","type":"LOCAL"}],"standard_charges":[{"gross_charge":1954.78,"discounted_cash":1368.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877877 = Hospital System Supply Identifier | 876544 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 3 HL HD 3HL","code_information":[{"code":"Sx00-1005-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877878","type":"LOCAL"},{"code":"876545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1826.28,"discounted_cash":1278.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877878 = Hospital System Supply Identifier | 876545 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 3 HL HD 5HL","code_information":[{"code":"Sx00-1005-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877879","type":"LOCAL"},{"code":"876546","type":"LOCAL"}],"standard_charges":[{"gross_charge":1954.78,"discounted_cash":1368.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877879 = Hospital System Supply Identifier | 876546 = Lawson ID"}]},{"description":"PLATE T LOK 3.5 3 HL HD 7HL","code_information":[{"code":"Sx00-1005-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877880","type":"LOCAL"},{"code":"876547","type":"LOCAL"}],"standard_charges":[{"gross_charge":2473.57,"discounted_cash":1731.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877880 = Hospital System Supply Identifier | 876547 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 18","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877885","type":"LOCAL"},{"code":"876552","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877885 = Hospital System Supply Identifier | 876552 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 16","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877884","type":"LOCAL"},{"code":"876551","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877884 = Hospital System Supply Identifier | 876551 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 14","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877883","type":"LOCAL"},{"code":"876550","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877883 = Hospital System Supply Identifier | 876550 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 12","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877882","type":"LOCAL"},{"code":"876549","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877882 = Hospital System Supply Identifier | 876549 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 10","code_information":[{"code":"Sx00-1005-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877881","type":"LOCAL"},{"code":"876548","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877881 = Hospital System Supply Identifier | 876548 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 20","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877886","type":"LOCAL"},{"code":"876553","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877886 = Hospital System Supply Identifier | 876553 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 22","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877887","type":"LOCAL"},{"code":"876554","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877887 = Hospital System Supply Identifier | 876554 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 24","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877888","type":"LOCAL"},{"code":"876555","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877888 = Hospital System Supply Identifier | 876555 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 26","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877889","type":"LOCAL"},{"code":"876556","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877889 = Hospital System Supply Identifier | 876556 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 28","code_information":[{"code":"Sx00-1005-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877890","type":"LOCAL"},{"code":"876557","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877890 = Hospital System Supply Identifier | 876557 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 38","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877896","type":"LOCAL"},{"code":"876563","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877896 = Hospital System Supply Identifier | 876563 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 36","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877895","type":"LOCAL"},{"code":"876562","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877895 = Hospital System Supply Identifier | 876562 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 35","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877894","type":"LOCAL"},{"code":"876561","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877894 = Hospital System Supply Identifier | 876561 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 34","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877893","type":"LOCAL"},{"code":"876560","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877893 = Hospital System Supply Identifier | 876560 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 32","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877892","type":"LOCAL"},{"code":"876559","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877892 = Hospital System Supply Identifier | 876559 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 30","code_information":[{"code":"Sx00-1005-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877891","type":"LOCAL"},{"code":"876558","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877891 = Hospital System Supply Identifier | 876558 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 40","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877897","type":"LOCAL"},{"code":"876564","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877897 = Hospital System Supply Identifier | 876564 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 42","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877898","type":"LOCAL"},{"code":"876565","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877898 = Hospital System Supply Identifier | 876565 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 44","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877899","type":"LOCAL"},{"code":"876566","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877899 = Hospital System Supply Identifier | 876566 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 45","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877900","type":"LOCAL"},{"code":"876567","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877900 = Hospital System Supply Identifier | 876567 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 46","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877901","type":"LOCAL"},{"code":"876568","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877901 = Hospital System Supply Identifier | 876568 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 48","code_information":[{"code":"Sx00-1005-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877902","type":"LOCAL"},{"code":"876569","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877902 = Hospital System Supply Identifier | 876569 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 55","code_information":[{"code":"Sx00-1005-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877904","type":"LOCAL"},{"code":"876571","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877904 = Hospital System Supply Identifier | 876571 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 50","code_information":[{"code":"Sx00-1005-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877903","type":"LOCAL"},{"code":"876570","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877903 = Hospital System Supply Identifier | 876570 = Lawson ID"}]},{"description":"SCREW CANN CANC F/T 4.0 T15 60","code_information":[{"code":"Sx00-1005-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877905","type":"LOCAL"},{"code":"876572","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877905 = Hospital System Supply Identifier | 876572 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 16","code_information":[{"code":"Sx00-1005-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877906","type":"LOCAL"},{"code":"876573","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877906 = Hospital System Supply Identifier | 876573 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 18","code_information":[{"code":"Sx00-1005-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877907","type":"LOCAL"},{"code":"876574","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877907 = Hospital System Supply Identifier | 876574 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 28","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877912","type":"LOCAL"},{"code":"876579","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877912 = Hospital System Supply Identifier | 876579 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 20","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877908","type":"LOCAL"},{"code":"876575","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877908 = Hospital System Supply Identifier | 876575 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 22","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877909","type":"LOCAL"},{"code":"876576","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877909 = Hospital System Supply Identifier | 876576 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 24","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877910","type":"LOCAL"},{"code":"876577","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877910 = Hospital System Supply Identifier | 876577 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 26","code_information":[{"code":"Sx00-1005-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877911","type":"LOCAL"},{"code":"876578","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877911 = Hospital System Supply Identifier | 876578 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 30","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877913","type":"LOCAL"},{"code":"876580","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877913 = Hospital System Supply Identifier | 876580 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 32","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877914","type":"LOCAL"},{"code":"876581","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877914 = Hospital System Supply Identifier | 876581 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 34","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877915","type":"LOCAL"},{"code":"876582","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877915 = Hospital System Supply Identifier | 876582 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 35","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877916","type":"LOCAL"},{"code":"876583","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877916 = Hospital System Supply Identifier | 876583 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 36","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877917","type":"LOCAL"},{"code":"876584","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877917 = Hospital System Supply Identifier | 876584 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 38","code_information":[{"code":"Sx00-1005-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877918","type":"LOCAL"},{"code":"876585","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877918 = Hospital System Supply Identifier | 876585 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 48","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877924","type":"LOCAL"},{"code":"876591","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877924 = Hospital System Supply Identifier | 876591 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 46","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877923","type":"LOCAL"},{"code":"876590","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877923 = Hospital System Supply Identifier | 876590 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 45","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877922","type":"LOCAL"},{"code":"876589","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877922 = Hospital System Supply Identifier | 876589 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 42","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877920","type":"LOCAL"},{"code":"876587","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877920 = Hospital System Supply Identifier | 876587 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 40","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877919","type":"LOCAL"},{"code":"876586","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877919 = Hospital System Supply Identifier | 876586 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 44","code_information":[{"code":"Sx00-1005-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877921","type":"LOCAL"},{"code":"876588","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877921 = Hospital System Supply Identifier | 876588 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 50","code_information":[{"code":"Sx00-1005-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877925","type":"LOCAL"},{"code":"876592","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877925 = Hospital System Supply Identifier | 876592 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 55","code_information":[{"code":"Sx00-1005-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877926","type":"LOCAL"},{"code":"876593","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877926 = Hospital System Supply Identifier | 876593 = Lawson ID"}]},{"description":"SCREW CANN CANC P/T 4.0 T15 60","code_information":[{"code":"Sx00-1005-426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877927","type":"LOCAL"},{"code":"876594","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877927 = Hospital System Supply Identifier | 876594 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 8HL RT","code_information":[{"code":"Sx00-1005-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877930","type":"LOCAL"},{"code":"876597","type":"LOCAL"}],"standard_charges":[{"gross_charge":3465.0,"discounted_cash":2425.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877930 = Hospital System Supply Identifier | 876597 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 6HL RT","code_information":[{"code":"Sx00-1005-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877928","type":"LOCAL"},{"code":"876595","type":"LOCAL"}],"standard_charges":[{"gross_charge":3465.0,"discounted_cash":2425.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877928 = Hospital System Supply Identifier | 876595 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 7HL RT","code_information":[{"code":"Sx00-1005-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877929","type":"LOCAL"},{"code":"876596","type":"LOCAL"}],"standard_charges":[{"gross_charge":3465.0,"discounted_cash":2425.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877929 = Hospital System Supply Identifier | 876596 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 8HL LT","code_information":[{"code":"Sx00-1005-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877933","type":"LOCAL"},{"code":"876600","type":"LOCAL"}],"standard_charges":[{"gross_charge":3465.0,"discounted_cash":2425.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877933 = Hospital System Supply Identifier | 876600 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 6HL LT","code_information":[{"code":"Sx00-1005-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877931","type":"LOCAL"},{"code":"876598","type":"LOCAL"}],"standard_charges":[{"gross_charge":3465.0,"discounted_cash":2425.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877931 = Hospital System Supply Identifier | 876598 = Lawson ID"}]},{"description":"PLATE CLAV 2.7MM 7HL LT","code_information":[{"code":"Sx00-1005-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877932","type":"LOCAL"},{"code":"876599","type":"LOCAL"}],"standard_charges":[{"gross_charge":3465.0,"discounted_cash":2425.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877932 = Hospital System Supply Identifier | 876599 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 6HL RT","code_information":[{"code":"Sx00-1005-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877934","type":"LOCAL"},{"code":"876601","type":"LOCAL"}],"standard_charges":[{"gross_charge":4056.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877934 = Hospital System Supply Identifier | 876601 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 7HL RT","code_information":[{"code":"Sx00-1005-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877935","type":"LOCAL"},{"code":"876602","type":"LOCAL"}],"standard_charges":[{"gross_charge":4056.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877935 = Hospital System Supply Identifier | 876602 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 8HL RT","code_information":[{"code":"Sx00-1005-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877936","type":"LOCAL"},{"code":"876603","type":"LOCAL"}],"standard_charges":[{"gross_charge":4056.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877936 = Hospital System Supply Identifier | 876603 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 7HL LT","code_information":[{"code":"Sx00-1005-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877938","type":"LOCAL"},{"code":"876605","type":"LOCAL"}],"standard_charges":[{"gross_charge":4056.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877938 = Hospital System Supply Identifier | 876605 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 6HL LT","code_information":[{"code":"Sx00-1005-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877937","type":"LOCAL"},{"code":"876604","type":"LOCAL"}],"standard_charges":[{"gross_charge":4056.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877937 = Hospital System Supply Identifier | 876604 = Lawson ID"}]},{"description":"PLATE CLAV 3.5MM 8HL LT","code_information":[{"code":"Sx00-1005-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877939","type":"LOCAL"},{"code":"876606","type":"LOCAL"}],"standard_charges":[{"gross_charge":4056.0,"discounted_cash":2839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877939 = Hospital System Supply Identifier | 876606 = Lawson ID"}]},{"description":"PLATE WRST FUS 2.7/3.5 99MM","code_information":[{"code":"Sx00-1005-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877940","type":"LOCAL"},{"code":"876607","type":"LOCAL"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":3244.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877940 = Hospital System Supply Identifier | 876607 = Lawson ID"}]},{"description":"PLATE WRST FUS 2.7/3.5 112MM","code_information":[{"code":"Sx00-1005-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877941","type":"LOCAL"},{"code":"876608","type":"LOCAL"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":3244.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877941 = Hospital System Supply Identifier | 876608 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 15MM","code_information":[{"code":"Sx00-1007-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877943","type":"LOCAL"},{"code":"876610","type":"LOCAL"}],"standard_charges":[{"gross_charge":4672.08,"discounted_cash":3270.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877943 = Hospital System Supply Identifier | 876610 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 12MM","code_information":[{"code":"Sx00-1007-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877942","type":"LOCAL"},{"code":"876609","type":"LOCAL"}],"standard_charges":[{"gross_charge":4672.08,"discounted_cash":3270.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877942 = Hospital System Supply Identifier | 876609 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 18MM","code_information":[{"code":"Sx00-1007-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877944","type":"LOCAL"},{"code":"876611","type":"LOCAL"}],"standard_charges":[{"gross_charge":4672.08,"discounted_cash":3270.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877944 = Hospital System Supply Identifier | 876611 = Lawson ID"}]},{"description":"PLATE COMP 2.7MM 2HL 21MM","code_information":[{"code":"Sx00-1007-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877945","type":"LOCAL"},{"code":"876612","type":"LOCAL"}],"standard_charges":[{"gross_charge":4672.08,"discounted_cash":3270.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877945 = Hospital System Supply Identifier | 876612 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 3HL 12MM","code_information":[{"code":"Sx00-1007-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877946","type":"LOCAL"},{"code":"876613","type":"LOCAL"}],"standard_charges":[{"gross_charge":5277.72,"discounted_cash":3694.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877946 = Hospital System Supply Identifier | 876613 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 3HL 15MM","code_information":[{"code":"Sx00-1007-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877947","type":"LOCAL"},{"code":"876614","type":"LOCAL"}],"standard_charges":[{"gross_charge":5277.72,"discounted_cash":3694.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877947 = Hospital System Supply Identifier | 876614 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 4HL 18MM","code_information":[{"code":"Sx00-1007-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877948","type":"LOCAL"},{"code":"876615","type":"LOCAL"}],"standard_charges":[{"gross_charge":5569.2,"discounted_cash":3898.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877948 = Hospital System Supply Identifier | 876615 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 4HL 21MM","code_information":[{"code":"Sx00-1007-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877949","type":"LOCAL"},{"code":"876616","type":"LOCAL"}],"standard_charges":[{"gross_charge":5569.2,"discounted_cash":3898.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877949 = Hospital System Supply Identifier | 876616 = Lawson ID"}]},{"description":"PLATE T COMP 2.7MM 4HL 24MM","code_information":[{"code":"Sx00-1007-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877950","type":"LOCAL"},{"code":"876617","type":"LOCAL"}],"standard_charges":[{"gross_charge":5569.2,"discounted_cash":3898.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877950 = Hospital System Supply Identifier | 876617 = Lawson ID"}]},{"description":"PLATE CLOVER 2.7MM 4HL","code_information":[{"code":"Sx00-1007-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877951","type":"LOCAL"},{"code":"876618","type":"LOCAL"}],"standard_charges":[{"gross_charge":3880.8,"discounted_cash":2716.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877951 = Hospital System Supply Identifier | 876618 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 15MM","code_information":[{"code":"Sx00-1007-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877952","type":"LOCAL"},{"code":"876619","type":"LOCAL"}],"standard_charges":[{"gross_charge":5740.56,"discounted_cash":4018.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877952 = Hospital System Supply Identifier | 876619 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 18MM","code_information":[{"code":"Sx00-1007-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877953","type":"LOCAL"},{"code":"876620","type":"LOCAL"}],"standard_charges":[{"gross_charge":5740.56,"discounted_cash":4018.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877953 = Hospital System Supply Identifier | 876620 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 27MM","code_information":[{"code":"Sx00-1007-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877956","type":"LOCAL"},{"code":"876623","type":"LOCAL"}],"standard_charges":[{"gross_charge":5740.56,"discounted_cash":4018.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877956 = Hospital System Supply Identifier | 876623 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 21MM","code_information":[{"code":"Sx00-1007-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877954","type":"LOCAL"},{"code":"876621","type":"LOCAL"}],"standard_charges":[{"gross_charge":5740.56,"discounted_cash":4018.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877954 = Hospital System Supply Identifier | 876621 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 24MM","code_information":[{"code":"Sx00-1007-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877955","type":"LOCAL"},{"code":"876622","type":"LOCAL"}],"standard_charges":[{"gross_charge":5740.56,"discounted_cash":4018.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877955 = Hospital System Supply Identifier | 876622 = Lawson ID"}]},{"description":"PLATE I COMP 2.7MM 4HL 30MM","code_information":[{"code":"Sx00-1007-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877957","type":"LOCAL"},{"code":"876624","type":"LOCAL"}],"standard_charges":[{"gross_charge":5740.56,"discounted_cash":4018.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877957 = Hospital System Supply Identifier | 876624 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 8HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877961","type":"LOCAL"},{"code":"876628","type":"LOCAL"}],"standard_charges":[{"gross_charge":6022.08,"discounted_cash":4215.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877961 = Hospital System Supply Identifier | 876628 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 2HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877958","type":"LOCAL"},{"code":"876625","type":"LOCAL"}],"standard_charges":[{"gross_charge":3515.4,"discounted_cash":2460.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877958 = Hospital System Supply Identifier | 876625 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 4HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877959","type":"LOCAL"},{"code":"876626","type":"LOCAL"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":3057.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877959 = Hospital System Supply Identifier | 876626 = Lawson ID"}]},{"description":"PLATE RECON 2.7MM 6HL","code_information":[{"code":"Sx00-1007-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877960","type":"LOCAL"},{"code":"876627","type":"LOCAL"}],"standard_charges":[{"gross_charge":5215.92,"discounted_cash":3651.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877960 = Hospital System Supply Identifier | 876627 = Lawson ID"}]},{"description":"ANGLE IRON 2.7MM 5MM","code_information":[{"code":"Sx00-1007-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877962","type":"LOCAL"},{"code":"876629","type":"LOCAL"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":3057.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877962 = Hospital System Supply Identifier | 876629 = Lawson ID"}]},{"description":"PLATE T WDG 2.7MM 4HL 4MM WDG","code_information":[{"code":"Sx00-1007-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877964","type":"LOCAL"},{"code":"876631","type":"LOCAL"}],"standard_charges":[{"gross_charge":6213.76,"discounted_cash":4349.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877964 = Hospital System Supply Identifier | 876631 = Lawson ID"}]},{"description":"PLATE T WDG 2.7MM 4HL 2MM WDG","code_information":[{"code":"Sx00-1007-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877963","type":"LOCAL"},{"code":"876630","type":"LOCAL"}],"standard_charges":[{"gross_charge":5997.6,"discounted_cash":4198.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877963 = Hospital System Supply Identifier | 876630 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 15MM","code_information":[{"code":"Sx00-1007-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877965","type":"LOCAL"},{"code":"876632","type":"LOCAL"}],"standard_charges":[{"gross_charge":5569.2,"discounted_cash":3898.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877965 = Hospital System Supply Identifier | 876632 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 18MM","code_information":[{"code":"Sx00-1007-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877966","type":"LOCAL"},{"code":"876633","type":"LOCAL"}],"standard_charges":[{"gross_charge":5569.2,"discounted_cash":3898.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877966 = Hospital System Supply Identifier | 876633 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 21MM","code_information":[{"code":"Sx00-1007-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877967","type":"LOCAL"},{"code":"876634","type":"LOCAL"}],"standard_charges":[{"gross_charge":5569.2,"discounted_cash":3898.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877967 = Hospital System Supply Identifier | 876634 = Lawson ID"}]},{"description":"PLATE COMP 3.5MM 2HL 24MM","code_information":[{"code":"Sx00-1007-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877968","type":"LOCAL"},{"code":"876635","type":"LOCAL"}],"standard_charges":[{"gross_charge":5569.2,"discounted_cash":3898.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877968 = Hospital System Supply Identifier | 876635 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 3HL 15MM","code_information":[{"code":"Sx00-1007-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877969","type":"LOCAL"},{"code":"876636","type":"LOCAL"}],"standard_charges":[{"gross_charge":6225.92,"discounted_cash":4358.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877969 = Hospital System Supply Identifier | 876636 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 3HL 18MM","code_information":[{"code":"Sx00-1007-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877970","type":"LOCAL"},{"code":"876637","type":"LOCAL"}],"standard_charges":[{"gross_charge":6225.92,"discounted_cash":4358.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877970 = Hospital System Supply Identifier | 876637 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 4HL 27MM","code_information":[{"code":"Sx00-1007-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877973","type":"LOCAL"},{"code":"876640","type":"LOCAL"}],"standard_charges":[{"gross_charge":6639.36,"discounted_cash":4647.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877973 = Hospital System Supply Identifier | 876640 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 4HL 21MM","code_information":[{"code":"Sx00-1007-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877971","type":"LOCAL"},{"code":"876638","type":"LOCAL"}],"standard_charges":[{"gross_charge":6639.36,"discounted_cash":4647.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877971 = Hospital System Supply Identifier | 876638 = Lawson ID"}]},{"description":"PLATE T COMP 3.5MM 4HL 24MM","code_information":[{"code":"Sx00-1007-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877972","type":"LOCAL"},{"code":"876639","type":"LOCAL"}],"standard_charges":[{"gross_charge":6639.36,"discounted_cash":4647.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877972 = Hospital System Supply Identifier | 876639 = Lawson ID"}]},{"description":"PLATE CLOVER 3.5MM 4HL","code_information":[{"code":"Sx00-1007-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877974","type":"LOCAL"},{"code":"876641","type":"LOCAL"}],"standard_charges":[{"gross_charge":5661.0,"discounted_cash":3962.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877974 = Hospital System Supply Identifier | 876641 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 15MM","code_information":[{"code":"Sx00-1007-131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877975","type":"LOCAL"},{"code":"876642","type":"LOCAL"}],"standard_charges":[{"gross_charge":6801.04,"discounted_cash":4760.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877975 = Hospital System Supply Identifier | 876642 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 18MM","code_information":[{"code":"Sx00-1007-131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877976","type":"LOCAL"},{"code":"876643","type":"LOCAL"}],"standard_charges":[{"gross_charge":6801.04,"discounted_cash":4760.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877976 = Hospital System Supply Identifier | 876643 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 21MM","code_information":[{"code":"Sx00-1007-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877977","type":"LOCAL"},{"code":"876644","type":"LOCAL"}],"standard_charges":[{"gross_charge":6801.04,"discounted_cash":4760.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877977 = Hospital System Supply Identifier | 876644 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 24MM","code_information":[{"code":"Sx00-1007-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877978","type":"LOCAL"},{"code":"876645","type":"LOCAL"}],"standard_charges":[{"gross_charge":6801.04,"discounted_cash":4760.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877978 = Hospital System Supply Identifier | 876645 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 27MM","code_information":[{"code":"Sx00-1007-132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877979","type":"LOCAL"},{"code":"876646","type":"LOCAL"}],"standard_charges":[{"gross_charge":6801.04,"discounted_cash":4760.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877979 = Hospital System Supply Identifier | 876646 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 33MM","code_information":[{"code":"Sx00-1007-133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877981","type":"LOCAL"},{"code":"876648","type":"LOCAL"}],"standard_charges":[{"gross_charge":6801.04,"discounted_cash":4760.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877981 = Hospital System Supply Identifier | 876648 = Lawson ID"}]},{"description":"PLATE I COMP 3.5MM 4HL 30MM","code_information":[{"code":"Sx00-1007-133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877980","type":"LOCAL"},{"code":"876647","type":"LOCAL"}],"standard_charges":[{"gross_charge":6801.04,"discounted_cash":4760.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877980 = Hospital System Supply Identifier | 876647 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 6HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877984","type":"LOCAL"},{"code":"876651","type":"LOCAL"}],"standard_charges":[{"gross_charge":6140.8,"discounted_cash":4298.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877984 = Hospital System Supply Identifier | 876651 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 8HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877985","type":"LOCAL"},{"code":"876652","type":"LOCAL"}],"standard_charges":[{"gross_charge":7127.2,"discounted_cash":4989.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877985 = Hospital System Supply Identifier | 876652 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 2HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877982","type":"LOCAL"},{"code":"876649","type":"LOCAL"}],"standard_charges":[{"gross_charge":4180.8,"discounted_cash":2926.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877982 = Hospital System Supply Identifier | 876649 = Lawson ID"}]},{"description":"PLATE RECON 3.5MM 4HL","code_information":[{"code":"Sx00-1007-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877983","type":"LOCAL"},{"code":"876650","type":"LOCAL"}],"standard_charges":[{"gross_charge":5191.2,"discounted_cash":3633.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877983 = Hospital System Supply Identifier | 876650 = Lawson ID"}]},{"description":"PLATE T WDG 3.5MM 4HL 4MM WDG","code_information":[{"code":"Sx00-1007-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877986","type":"LOCAL"},{"code":"876653","type":"LOCAL"}],"standard_charges":[{"gross_charge":7103.04,"discounted_cash":4972.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877986 = Hospital System Supply Identifier | 876653 = Lawson ID"}]},{"description":"PLATE T WDG 3.5MM 4HL 6MM WDG","code_information":[{"code":"Sx00-1007-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877987","type":"LOCAL"},{"code":"876654","type":"LOCAL"}],"standard_charges":[{"gross_charge":7368.8,"discounted_cash":5158.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877987 = Hospital System Supply Identifier | 876654 = Lawson ID"}]},{"description":"ANGLE IRON 3.5MM 6MM","code_information":[{"code":"Sx00-1007-160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877988","type":"LOCAL"},{"code":"876655","type":"LOCAL"}],"standard_charges":[{"gross_charge":5191.2,"discounted_cash":3633.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877988 = Hospital System Supply Identifier | 876655 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X6MM","code_information":[{"code":"Sx00-1007-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877989","type":"LOCAL"},{"code":"876656","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877989 = Hospital System Supply Identifier | 876656 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X8MM","code_information":[{"code":"Sx00-1007-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877990","type":"LOCAL"},{"code":"876657","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877990 = Hospital System Supply Identifier | 876657 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X18MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877995","type":"LOCAL"},{"code":"876662","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877995 = Hospital System Supply Identifier | 876662 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X16MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877994","type":"LOCAL"},{"code":"876661","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877994 = Hospital System Supply Identifier | 876661 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X14MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877993","type":"LOCAL"},{"code":"876660","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877993 = Hospital System Supply Identifier | 876660 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X10MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877991","type":"LOCAL"},{"code":"876658","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877991 = Hospital System Supply Identifier | 876658 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X12MM","code_information":[{"code":"Sx00-1007-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877992","type":"LOCAL"},{"code":"876659","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877992 = Hospital System Supply Identifier | 876659 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X20MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877996","type":"LOCAL"},{"code":"876663","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877996 = Hospital System Supply Identifier | 876663 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X22MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877997","type":"LOCAL"},{"code":"876664","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877997 = Hospital System Supply Identifier | 876664 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X24MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877998","type":"LOCAL"},{"code":"876665","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877998 = Hospital System Supply Identifier | 876665 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X26MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"877999","type":"LOCAL"},{"code":"876666","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 877999 = Hospital System Supply Identifier | 876666 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X28MM","code_information":[{"code":"Sx00-1007-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878000","type":"LOCAL"},{"code":"876667","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878000 = Hospital System Supply Identifier | 876667 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X38MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878005","type":"LOCAL"},{"code":"876672","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878005 = Hospital System Supply Identifier | 876672 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X34MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878003","type":"LOCAL"},{"code":"876670","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878003 = Hospital System Supply Identifier | 876670 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X36MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878004","type":"LOCAL"},{"code":"876671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878004 = Hospital System Supply Identifier | 876671 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X30MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878001","type":"LOCAL"},{"code":"876668","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878001 = Hospital System Supply Identifier | 876668 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X32MM","code_information":[{"code":"Sx00-1007-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878002","type":"LOCAL"},{"code":"876669","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878002 = Hospital System Supply Identifier | 876669 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X40MM","code_information":[{"code":"Sx00-1007-274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878006","type":"LOCAL"},{"code":"876673","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878006 = Hospital System Supply Identifier | 876673 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X44MM","code_information":[{"code":"Sx00-1007-274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878007","type":"LOCAL"},{"code":"876674","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878007 = Hospital System Supply Identifier | 876674 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X48MM","code_information":[{"code":"Sx00-1007-274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878008","type":"LOCAL"},{"code":"876675","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878008 = Hospital System Supply Identifier | 876675 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X52MM","code_information":[{"code":"Sx00-1007-275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878009","type":"LOCAL"},{"code":"876676","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878009 = Hospital System Supply Identifier | 876676 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X56MM","code_information":[{"code":"Sx00-1007-275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878010","type":"LOCAL"},{"code":"876677","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878010 = Hospital System Supply Identifier | 876677 = Lawson ID"}]},{"description":"SCREW LOK V/A 2.7X60MM","code_information":[{"code":"Sx00-1007-276","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878011","type":"LOCAL"},{"code":"876678","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878011 = Hospital System Supply Identifier | 876678 = Lawson ID"}]},{"description":"SCREW CORT 2.7X6MM","code_information":[{"code":"Sx00-1007-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878012","type":"LOCAL"},{"code":"876679","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878012 = Hospital System Supply Identifier | 876679 = Lawson ID"}]},{"description":"SCREW CORT 2.7X8MM","code_information":[{"code":"Sx00-1007-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878013","type":"LOCAL"},{"code":"876680","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878013 = Hospital System Supply Identifier | 876680 = Lawson ID"}]},{"description":"SCREW CORT 2.7X18MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878018","type":"LOCAL"},{"code":"876685","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878018 = Hospital System Supply Identifier | 876685 = Lawson ID"}]},{"description":"SCREW CORT 2.7X16MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878017","type":"LOCAL"},{"code":"876684","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878017 = Hospital System Supply Identifier | 876684 = Lawson ID"}]},{"description":"SCREW CORT 2.7X10MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878014","type":"LOCAL"},{"code":"876681","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878014 = Hospital System Supply Identifier | 876681 = Lawson ID"}]},{"description":"SCREW CORT 2.7X12MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878015","type":"LOCAL"},{"code":"876682","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878015 = Hospital System Supply Identifier | 876682 = Lawson ID"}]},{"description":"SCREW CORT 2.7X14MM","code_information":[{"code":"Sx00-1007-281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878016","type":"LOCAL"},{"code":"876683","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878016 = Hospital System Supply Identifier | 876683 = Lawson ID"}]},{"description":"SCREW CORT 2.7X20MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878019","type":"LOCAL"},{"code":"876686","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878019 = Hospital System Supply Identifier | 876686 = Lawson ID"}]},{"description":"SCREW CORT 2.7X22MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878020","type":"LOCAL"},{"code":"876687","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878020 = Hospital System Supply Identifier | 876687 = Lawson ID"}]},{"description":"SCREW CORT 2.7X24MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878021","type":"LOCAL"},{"code":"876688","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878021 = Hospital System Supply Identifier | 876688 = Lawson ID"}]},{"description":"SCREW CORT 2.7X26MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878022","type":"LOCAL"},{"code":"876689","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878022 = Hospital System Supply Identifier | 876689 = Lawson ID"}]},{"description":"SCREW CORT 2.7X28MM","code_information":[{"code":"Sx00-1007-282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878023","type":"LOCAL"},{"code":"876690","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878023 = Hospital System Supply Identifier | 876690 = Lawson ID"}]},{"description":"SCREW CORT 2.7X38MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878028","type":"LOCAL"},{"code":"876695","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878028 = Hospital System Supply Identifier | 876695 = Lawson ID"}]},{"description":"SCREW CORT 2.7X36MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878027","type":"LOCAL"},{"code":"876694","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878027 = Hospital System Supply Identifier | 876694 = Lawson ID"}]},{"description":"SCREW CORT 2.7X34MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878026","type":"LOCAL"},{"code":"876693","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878026 = Hospital System Supply Identifier | 876693 = Lawson ID"}]},{"description":"SCREW CORT 2.7X32MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878025","type":"LOCAL"},{"code":"876692","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878025 = Hospital System Supply Identifier | 876692 = Lawson ID"}]},{"description":"SCREW CORT 2.7X30MM","code_information":[{"code":"Sx00-1007-283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878024","type":"LOCAL"},{"code":"876691","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878024 = Hospital System Supply Identifier | 876691 = Lawson ID"}]},{"description":"SCREW CORT 2.7X40MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878029","type":"LOCAL"},{"code":"876696","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878029 = Hospital System Supply Identifier | 876696 = Lawson ID"}]},{"description":"SCREW CORT 2.7X44MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878030","type":"LOCAL"},{"code":"876697","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878030 = Hospital System Supply Identifier | 876697 = Lawson ID"}]},{"description":"SCREW CORT 2.7X48MM","code_information":[{"code":"Sx00-1007-284","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878031","type":"LOCAL"},{"code":"876698","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878031 = Hospital System Supply Identifier | 876698 = Lawson ID"}]},{"description":"SCREW CORT 2.7X52MM","code_information":[{"code":"Sx00-1007-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878032","type":"LOCAL"},{"code":"876699","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878032 = Hospital System Supply Identifier | 876699 = Lawson ID"}]},{"description":"SCREW CORT 2.7X56MM","code_information":[{"code":"Sx00-1007-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878033","type":"LOCAL"},{"code":"876700","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878033 = Hospital System Supply Identifier | 876700 = Lawson ID"}]},{"description":"SCREW CORT 2.7X60MM","code_information":[{"code":"Sx00-1007-286","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878034","type":"LOCAL"},{"code":"876701","type":"LOCAL"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878034 = Hospital System Supply Identifier | 876701 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X8MM","code_information":[{"code":"Sx00-1007-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878035","type":"LOCAL"},{"code":"876702","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878035 = Hospital System Supply Identifier | 876702 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X10MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878036","type":"LOCAL"},{"code":"876703","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878036 = Hospital System Supply Identifier | 876703 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X12MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878037","type":"LOCAL"},{"code":"876704","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878037 = Hospital System Supply Identifier | 876704 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X14MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878038","type":"LOCAL"},{"code":"876705","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878038 = Hospital System Supply Identifier | 876705 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X16MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878039","type":"LOCAL"},{"code":"876706","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878039 = Hospital System Supply Identifier | 876706 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X18MM","code_information":[{"code":"Sx00-1007-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878040","type":"LOCAL"},{"code":"876707","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878040 = Hospital System Supply Identifier | 876707 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X26MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878044","type":"LOCAL"},{"code":"876711","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878044 = Hospital System Supply Identifier | 876711 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X24MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878043","type":"LOCAL"},{"code":"876710","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878043 = Hospital System Supply Identifier | 876710 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X28MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878045","type":"LOCAL"},{"code":"876712","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878045 = Hospital System Supply Identifier | 876712 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X20MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878041","type":"LOCAL"},{"code":"876708","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878041 = Hospital System Supply Identifier | 876708 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X22MM","code_information":[{"code":"Sx00-1007-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878042","type":"LOCAL"},{"code":"876709","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878042 = Hospital System Supply Identifier | 876709 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X30MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878046","type":"LOCAL"},{"code":"876713","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878046 = Hospital System Supply Identifier | 876713 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X32MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878047","type":"LOCAL"},{"code":"876714","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878047 = Hospital System Supply Identifier | 876714 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X34MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878048","type":"LOCAL"},{"code":"876715","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878048 = Hospital System Supply Identifier | 876715 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X36MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878049","type":"LOCAL"},{"code":"876716","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878049 = Hospital System Supply Identifier | 876716 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X38MM","code_information":[{"code":"Sx00-1007-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878050","type":"LOCAL"},{"code":"876717","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878050 = Hospital System Supply Identifier | 876717 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X40MM","code_information":[{"code":"Sx00-1007-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878051","type":"LOCAL"},{"code":"876718","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878051 = Hospital System Supply Identifier | 876718 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X44MM","code_information":[{"code":"Sx00-1007-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878052","type":"LOCAL"},{"code":"876719","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878052 = Hospital System Supply Identifier | 876719 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X48MM","code_information":[{"code":"Sx00-1007-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878053","type":"LOCAL"},{"code":"876720","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878053 = Hospital System Supply Identifier | 876720 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X56MM","code_information":[{"code":"Sx00-1007-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878055","type":"LOCAL"},{"code":"876722","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878055 = Hospital System Supply Identifier | 876722 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X52MM","code_information":[{"code":"Sx00-1007-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878054","type":"LOCAL"},{"code":"876721","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878054 = Hospital System Supply Identifier | 876721 = Lawson ID"}]},{"description":"SCREW LOK V/A 3.5X60MM","code_information":[{"code":"Sx00-1007-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878056","type":"LOCAL"},{"code":"876723","type":"LOCAL"}],"standard_charges":[{"gross_charge":1358.8,"discounted_cash":951.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878056 = Hospital System Supply Identifier | 876723 = Lawson ID"}]},{"description":"SCREW CORT 3.5X8MM","code_information":[{"code":"Sx00-1007-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878057","type":"LOCAL"},{"code":"876724","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878057 = Hospital System Supply Identifier | 876724 = Lawson ID"}]},{"description":"SCREW CORT 3.5X10MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878058","type":"LOCAL"},{"code":"876725","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878058 = Hospital System Supply Identifier | 876725 = Lawson ID"}]},{"description":"SCREW CORT 3.5X12MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878059","type":"LOCAL"},{"code":"876726","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878059 = Hospital System Supply Identifier | 876726 = Lawson ID"}]},{"description":"SCREW CORT 3.5X14MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878060","type":"LOCAL"},{"code":"876727","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878060 = Hospital System Supply Identifier | 876727 = Lawson ID"}]},{"description":"SCREW CORT 3.5X16MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878061","type":"LOCAL"},{"code":"876728","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878061 = Hospital System Supply Identifier | 876728 = Lawson ID"}]},{"description":"SCREW CORT 3.5X18MM","code_information":[{"code":"Sx00-1007-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878062","type":"LOCAL"},{"code":"876729","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878062 = Hospital System Supply Identifier | 876729 = Lawson ID"}]},{"description":"SCREW CORT 3.5X28MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878067","type":"LOCAL"},{"code":"876734","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878067 = Hospital System Supply Identifier | 876734 = Lawson ID"}]},{"description":"SCREW CORT 3.5X24MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878065","type":"LOCAL"},{"code":"876732","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878065 = Hospital System Supply Identifier | 876732 = Lawson ID"}]},{"description":"SCREW CORT 3.5X26MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878066","type":"LOCAL"},{"code":"876733","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878066 = Hospital System Supply Identifier | 876733 = Lawson ID"}]},{"description":"SCREW CORT 3.5X22MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878064","type":"LOCAL"},{"code":"876731","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878064 = Hospital System Supply Identifier | 876731 = Lawson ID"}]},{"description":"SCREW CORT 3.5X20MM","code_information":[{"code":"Sx00-1007-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878063","type":"LOCAL"},{"code":"876730","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878063 = Hospital System Supply Identifier | 876730 = Lawson ID"}]},{"description":"SCREW CORT 3.5X30MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878068","type":"LOCAL"},{"code":"876735","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878068 = Hospital System Supply Identifier | 876735 = Lawson ID"}]},{"description":"SCREW CORT 3.5X32MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878069","type":"LOCAL"},{"code":"876736","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878069 = Hospital System Supply Identifier | 876736 = Lawson ID"}]},{"description":"SCREW CORT 3.5X34MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878070","type":"LOCAL"},{"code":"876737","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878070 = Hospital System Supply Identifier | 876737 = Lawson ID"}]},{"description":"SCREW CORT 3.5X36MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878071","type":"LOCAL"},{"code":"876738","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878071 = Hospital System Supply Identifier | 876738 = Lawson ID"}]},{"description":"SCREW CORT 3.5X38MM","code_information":[{"code":"Sx00-1007-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878072","type":"LOCAL"},{"code":"876739","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878072 = Hospital System Supply Identifier | 876739 = Lawson ID"}]},{"description":"SCREW CORT 3.5X44MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878074","type":"LOCAL"},{"code":"876741","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878074 = Hospital System Supply Identifier | 876741 = Lawson ID"}]},{"description":"SCREW CORT 3.5X48MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878075","type":"LOCAL"},{"code":"876742","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878075 = Hospital System Supply Identifier | 876742 = Lawson ID"}]},{"description":"SCREW CORT 3.5X40MM","code_information":[{"code":"Sx00-1007-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878073","type":"LOCAL"},{"code":"876740","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878073 = Hospital System Supply Identifier | 876740 = Lawson ID"}]},{"description":"SCREW CORT 3.5X52MM","code_information":[{"code":"Sx00-1007-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878076","type":"LOCAL"},{"code":"876743","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878076 = Hospital System Supply Identifier | 876743 = Lawson ID"}]},{"description":"SCREW CORT 3.5X56MM","code_information":[{"code":"Sx00-1007-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878077","type":"LOCAL"},{"code":"876744","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878077 = Hospital System Supply Identifier | 876744 = Lawson ID"}]},{"description":"SCREW CORT 3.5X60MM","code_information":[{"code":"Sx00-1007-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878078","type":"LOCAL"},{"code":"876745","type":"LOCAL"}],"standard_charges":[{"gross_charge":980.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878078 = Hospital System Supply Identifier | 876745 = Lawson ID"}]},{"description":"PLATE LVL1 MINI STR 20HL 100MM","code_information":[{"code":"Sx00-101-30-9","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"650259","type":"LOCAL"},{"code":"723730","type":"LOCAL"}],"standard_charges":[{"gross_charge":411.65,"discounted_cash":288.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 650259 = Hospital System Supply Identifier | 723730 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP RT 2X2HL 20MM","code_information":[{"code":"Sx00-101-56-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"650261","type":"LOCAL"},{"code":"723732","type":"LOCAL"}],"standard_charges":[{"gross_charge":517.95,"discounted_cash":362.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 650261 = Hospital System Supply Identifier | 723732 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP LT 2X2HL 20MM","code_information":[{"code":"Sx00-101-57-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"650262","type":"LOCAL"},{"code":"723733","type":"LOCAL"}],"standard_charges":[{"gross_charge":517.95,"discounted_cash":362.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 650262 = Hospital System Supply Identifier | 723733 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP RT 2X2HL 24MM","code_information":[{"code":"Sx00-101-58-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"650263","type":"LOCAL"},{"code":"723734","type":"LOCAL"}],"standard_charges":[{"gross_charge":377.35,"discounted_cash":264.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 650263 = Hospital System Supply Identifier | 723734 = Lawson ID"}]},{"description":"PLATE LVL1 L-SHP LT 2X2HL 24MM","code_information":[{"code":"Sx00-101-59-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"650264","type":"LOCAL"},{"code":"723735","type":"LOCAL"}],"standard_charges":[{"gross_charge":377.35,"discounted_cash":264.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 650264 = Hospital System Supply Identifier | 723735 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE KNEE STAINLESS-STEEL CENTER-HOLE","code_information":[{"code":"Sx00-1010-214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176175","type":"LOCAL"},{"code":"1083608","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.53,"discounted_cash":1344.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176175 = Hospital System Supply Identifier | 1083608 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE KNEE STAINLESS-STEEL CENTER-HOLE","code_information":[{"code":"Sx00-1010-217","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176416","type":"LOCAL"},{"code":"1083538","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.53,"discounted_cash":1344.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176416 = Hospital System Supply Identifier | 1083538 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE KNEE STAINLESS-STEEL CENTER-HOLE","code_information":[{"code":"Sx00-1010-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176137","type":"LOCAL"},{"code":"1083690","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.53,"discounted_cash":1344.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176137 = Hospital System Supply Identifier | 1083690 = Lawson ID"}]},{"description":"PLATE-O DELTA 16MM","code_information":[{"code":"Sx00-1012-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"610180","type":"LOCAL"},{"code":"593216","type":"LOCAL"}],"standard_charges":[{"gross_charge":2364.27,"discounted_cash":1654.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 610180 = Hospital System Supply Identifier | 593216 = Lawson ID"}]},{"description":"PLATE DELTA 12MM","code_information":[{"code":"Sx00-1012-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878079","type":"LOCAL"},{"code":"876746","type":"LOCAL"}],"standard_charges":[{"gross_charge":2364.27,"discounted_cash":1654.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878079 = Hospital System Supply Identifier | 876746 = Lawson ID"}]},{"description":"PLATE-O DELTA 24MM","code_information":[{"code":"Sx00-1012-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"610179","type":"LOCAL"},{"code":"593215","type":"LOCAL"}],"standard_charges":[{"gross_charge":2364.27,"discounted_cash":1654.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 610179 = Hospital System Supply Identifier | 593215 = Lawson ID"}]},{"description":"PLATE DELTA 20MM","code_information":[{"code":"Sx00-1012-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878080","type":"LOCAL"},{"code":"876747","type":"LOCAL"}],"standard_charges":[{"gross_charge":2364.27,"discounted_cash":1654.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878080 = Hospital System Supply Identifier | 876747 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 12MM","code_information":[{"code":"Sx00-1012-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"586047","type":"LOCAL"},{"code":"410072","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.53,"discounted_cash":1344.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 586047 = Hospital System Supply Identifier | 410072 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 16MM","code_information":[{"code":"Sx00-1012-216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"586048","type":"LOCAL"},{"code":"410073","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.53,"discounted_cash":1344.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 586048 = Hospital System Supply Identifier | 410073 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 20MM","code_information":[{"code":"Sx00-1012-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"586049","type":"LOCAL"},{"code":"410074","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.53,"discounted_cash":1344.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 586049 = Hospital System Supply Identifier | 410074 = Lawson ID"}]},{"description":"PLATE PEDI O W/HLDR 24MM","code_information":[{"code":"Sx00-1012-224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"887544","type":"LOCAL"},{"code":"410075","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.53,"discounted_cash":1344.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 887544 = Hospital System Supply Identifier | 410075 = Lawson ID"}]},{"description":"SCREW CANN DELTA 4.5X16MM","code_information":[{"code":"Sx00-1015-071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"610182","type":"LOCAL"},{"code":"593218","type":"LOCAL"}],"standard_charges":[{"gross_charge":1227.49,"discounted_cash":859.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 610182 = Hospital System Supply Identifier | 593218 = Lawson ID"}]},{"description":"SCREW CANN DELTA 4.5X24MM","code_information":[{"code":"Sx00-1015-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"610181","type":"LOCAL"},{"code":"593217","type":"LOCAL"}],"standard_charges":[{"gross_charge":1227.49,"discounted_cash":859.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 610181 = Hospital System Supply Identifier | 593217 = Lawson ID"}]},{"description":"SCREW CANN DELTA 4.5X20MM","code_information":[{"code":"Sx00-1015-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"610183","type":"LOCAL"},{"code":"593219","type":"LOCAL"}],"standard_charges":[{"gross_charge":1227.49,"discounted_cash":859.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 610183 = Hospital System Supply Identifier | 593219 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.5X28MM","code_information":[{"code":"Sx00-1015-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878081","type":"LOCAL"},{"code":"876748","type":"LOCAL"}],"standard_charges":[{"gross_charge":1227.49,"discounted_cash":859.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878081 = Hospital System Supply Identifier | 876748 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.5X32MM","code_information":[{"code":"Sx00-1015-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878082","type":"LOCAL"},{"code":"876749","type":"LOCAL"}],"standard_charges":[{"gross_charge":1227.49,"discounted_cash":859.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878082 = Hospital System Supply Identifier | 876749 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.5X36MM","code_information":[{"code":"Sx00-1015-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878083","type":"LOCAL"},{"code":"876750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1227.49,"discounted_cash":859.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878083 = Hospital System Supply Identifier | 876750 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X12MM","code_information":[{"code":"Sx00-1015-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934231","type":"LOCAL"},{"code":"418940","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934231 = Hospital System Supply Identifier | 418940 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL SELF-TAPPING FT FOR-LAT","code_information":[{"code":"Sx00-1015-214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175909","type":"LOCAL"},{"code":"1083673","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175909 = Hospital System Supply Identifier | 1083673 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X16MM","code_information":[{"code":"Sx00-1015-216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934232","type":"LOCAL"},{"code":"399815","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934232 = Hospital System Supply Identifier | 399815 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X18MM","code_information":[{"code":"Sx00-1015-218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934233","type":"LOCAL"},{"code":"418942","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934233 = Hospital System Supply Identifier | 418942 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X24MM","code_information":[{"code":"Sx00-1015-224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934234","type":"LOCAL"},{"code":"399817","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934234 = Hospital System Supply Identifier | 399817 = Lawson ID"}]},{"description":"SCREW PEDPLATE CRTX 3.5X26MM","code_information":[{"code":"Sx00-1015-226","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934235","type":"LOCAL"},{"code":"418944","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934235 = Hospital System Supply Identifier | 418944 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL ST","code_information":[{"code":"Sx00-1015-228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176267","type":"LOCAL"},{"code":"1083629","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176267 = Hospital System Supply Identifier | 1083629 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT DIST FEM","code_information":[{"code":"Sx00-1015-230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176059","type":"LOCAL"},{"code":"1083563","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176059 = Hospital System Supply Identifier | 1083563 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT LAT DIST FEM","code_information":[{"code":"Sx00-1015-232","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176534","type":"LOCAL"},{"code":"1083682","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176534 = Hospital System Supply Identifier | 1083682 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT","code_information":[{"code":"Sx00-1015-234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175910","type":"LOCAL"},{"code":"1083676","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175910 = Hospital System Supply Identifier | 1083676 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT","code_information":[{"code":"Sx00-1015-236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176684","type":"LOCAL"},{"code":"1083560","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176684 = Hospital System Supply Identifier | 1083560 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FT FOR-LAT","code_information":[{"code":"Sx00-1015-238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176395","type":"LOCAL"},{"code":"1083601","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176395 = Hospital System Supply Identifier | 1083601 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176304","type":"LOCAL"},{"code":"1083646","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176304 = Hospital System Supply Identifier | 1083646 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175928","type":"LOCAL"},{"code":"1083652","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175928 = Hospital System Supply Identifier | 1083652 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176181","type":"LOCAL"},{"code":"1083606","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176181 = Hospital System Supply Identifier | 1083606 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176660","type":"LOCAL"},{"code":"1083678","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176660 = Hospital System Supply Identifier | 1083678 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176180","type":"LOCAL"},{"code":"1083567","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176180 = Hospital System Supply Identifier | 1083567 = Lawson ID"}]},{"description":"SCREW-BONE CORTICAL CANNULATED STAINLESS-STEEL FULL-THREAD","code_information":[{"code":"Sx00-1015-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176686","type":"LOCAL"},{"code":"1083541","type":"LOCAL"}],"standard_charges":[{"gross_charge":393.49,"discounted_cash":275.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176686 = Hospital System Supply Identifier | 1083541 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X16MM","code_information":[{"code":"Sx00-1015-316","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934236","type":"LOCAL"},{"code":"405712","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934236 = Hospital System Supply Identifier | 405712 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5","code_information":[{"code":"Sx00-1015-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934237","type":"LOCAL"},{"code":"424925","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934237 = Hospital System Supply Identifier | 424925 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X24MM","code_information":[{"code":"Sx00-1015-324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934238","type":"LOCAL"},{"code":"405713","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934238 = Hospital System Supply Identifier | 405713 = Lawson ID"}]},{"description":"SCREW CANN 4.5X28MM","code_information":[{"code":"Sx00-1015-328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878084","type":"LOCAL"},{"code":"876751","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878084 = Hospital System Supply Identifier | 876751 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X32MM","code_information":[{"code":"Sx00-1015-332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934239","type":"LOCAL"},{"code":"405714","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934239 = Hospital System Supply Identifier | 405714 = Lawson ID"}]},{"description":"SCREW CANN PED-PLT 4.5X36MM","code_information":[{"code":"Sx00-1015-336","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934240","type":"LOCAL"},{"code":"405715","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934240 = Hospital System Supply Identifier | 405715 = Lawson ID"}]},{"description":"PLATE PEDI I W/HLDR 16MM","code_information":[{"code":"Sx00-1015-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934242","type":"LOCAL"},{"code":"410076","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.53,"discounted_cash":1344.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934242 = Hospital System Supply Identifier | 410076 = Lawson ID"}]},{"description":"PLATE PEDI I W/HLDR 22MM","code_information":[{"code":"Sx00-1015-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934243","type":"LOCAL"},{"code":"410077","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.53,"discounted_cash":1344.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934243 = Hospital System Supply Identifier | 410077 = Lawson ID"}]},{"description":"PLATE PEDI I W/HLDR 32MM","code_information":[{"code":"Sx00-1015-432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934244","type":"LOCAL"},{"code":"410078","type":"LOCAL"}],"standard_charges":[{"gross_charge":1920.53,"discounted_cash":1344.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934244 = Hospital System Supply Identifier | 410078 = Lawson ID"}]},{"description":"SCREW SOLID 4.5X16MM","code_information":[{"code":"Sx00-1015-516","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878085","type":"LOCAL"},{"code":"876752","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878085 = Hospital System Supply Identifier | 876752 = Lawson ID"}]},{"description":"SCREW SOLID 4.5X20MM","code_information":[{"code":"Sx00-1015-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878086","type":"LOCAL"},{"code":"876753","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878086 = Hospital System Supply Identifier | 876753 = Lawson ID"}]},{"description":"SCREW BONE 244.5PEDIATRIC CANC","code_information":[{"code":"Sx00-1015-524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934245","type":"LOCAL"},{"code":"824274","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934245 = Hospital System Supply Identifier | 824274 = Lawson ID"}]},{"description":"SCREW BONE 284.5SELF TAP LOW P","code_information":[{"code":"Sx00-1015-528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934246","type":"LOCAL"},{"code":"824273","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934246 = Hospital System Supply Identifier | 824273 = Lawson ID"}]},{"description":"SCREW BONE 324.5LOW PROFILE SO","code_information":[{"code":"Sx00-1015-532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934247","type":"LOCAL"},{"code":"824272","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934247 = Hospital System Supply Identifier | 824272 = Lawson ID"}]},{"description":"SCREW SOLID 4.5X36MM","code_information":[{"code":"Sx00-1015-536","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878087","type":"LOCAL"},{"code":"876754","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878087 = Hospital System Supply Identifier | 876754 = Lawson ID"}]},{"description":"SCREW BONE 164.5CANN LOW PROFI","code_information":[{"code":"Sx00-1015-616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934249","type":"LOCAL"},{"code":"827490","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934249 = Hospital System Supply Identifier | 827490 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5X20MM","code_information":[{"code":"Sx00-1015-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"592173","type":"LOCAL"},{"code":"461780","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 592173 = Hospital System Supply Identifier | 461780 = Lawson ID"}]},{"description":"SCREW CANN LP 4.5X24MM","code_information":[{"code":"Sx00-1015-624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"603745","type":"LOCAL"},{"code":"536297","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 603745 = Hospital System Supply Identifier | 536297 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5X28MM","code_information":[{"code":"Sx00-1015-628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"592174","type":"LOCAL"},{"code":"461781","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 592174 = Hospital System Supply Identifier | 461781 = Lawson ID"}]},{"description":"SCREW CANN PEDIPLATE 4.5X32MM","code_information":[{"code":"Sx00-1015-632","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"592175","type":"LOCAL"},{"code":"461782","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 592175 = Hospital System Supply Identifier | 461782 = Lawson ID"}]},{"description":"SCREW BONE 364.5FEMORAL PHYSEA","code_information":[{"code":"Sx00-1015-636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934250","type":"LOCAL"},{"code":"823995","type":"LOCAL"}],"standard_charges":[{"gross_charge":1223.86,"discounted_cash":856.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934250 = Hospital System Supply Identifier | 823995 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 16MM","code_information":[{"code":"Sx00-1015-801","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878088","type":"LOCAL"},{"code":"876755","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878088 = Hospital System Supply Identifier | 876755 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 20MM","code_information":[{"code":"Sx00-1015-802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878089","type":"LOCAL"},{"code":"876756","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878089 = Hospital System Supply Identifier | 876756 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 24MM","code_information":[{"code":"Sx00-1015-802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878090","type":"LOCAL"},{"code":"876757","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878090 = Hospital System Supply Identifier | 876757 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 28MM","code_information":[{"code":"Sx00-1015-802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878091","type":"LOCAL"},{"code":"876758","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878091 = Hospital System Supply Identifier | 876758 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 32MM","code_information":[{"code":"Sx00-1015-803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878092","type":"LOCAL"},{"code":"876759","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878092 = Hospital System Supply Identifier | 876759 = Lawson ID"}]},{"description":"SCREW CANN TI 4.5X 36MM","code_information":[{"code":"Sx00-1015-803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878093","type":"LOCAL"},{"code":"876760","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878093 = Hospital System Supply Identifier | 876760 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 16MM","code_information":[{"code":"Sx00-1015-811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878094","type":"LOCAL"},{"code":"876761","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878094 = Hospital System Supply Identifier | 876761 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 28MM","code_information":[{"code":"Sx00-1015-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878097","type":"LOCAL"},{"code":"876764","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878097 = Hospital System Supply Identifier | 876764 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 24MM","code_information":[{"code":"Sx00-1015-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878096","type":"LOCAL"},{"code":"876763","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878096 = Hospital System Supply Identifier | 876763 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 20MM","code_information":[{"code":"Sx00-1015-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878095","type":"LOCAL"},{"code":"876762","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878095 = Hospital System Supply Identifier | 876762 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 32MM","code_information":[{"code":"Sx00-1015-813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878098","type":"LOCAL"},{"code":"876765","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878098 = Hospital System Supply Identifier | 876765 = Lawson ID"}]},{"description":"SCREW SOLID TI 4.5X 36MM","code_information":[{"code":"Sx00-1015-813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878099","type":"LOCAL"},{"code":"876766","type":"LOCAL"}],"standard_charges":[{"gross_charge":881.5,"discounted_cash":617.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878099 = Hospital System Supply Identifier | 876766 = Lawson ID"}]},{"description":"O-PLATE TI 12MM","code_information":[{"code":"Sx00-1015-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878100","type":"LOCAL"},{"code":"876767","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.0,"discounted_cash":1747.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878100 = Hospital System Supply Identifier | 876767 = Lawson ID"}]},{"description":"O-PLATE TI 16MM","code_information":[{"code":"Sx00-1015-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878101","type":"LOCAL"},{"code":"876768","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.0,"discounted_cash":1747.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878101 = Hospital System Supply Identifier | 876768 = Lawson ID"}]},{"description":"O-PLATE TI 20MM","code_information":[{"code":"Sx00-1015-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878102","type":"LOCAL"},{"code":"876769","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.0,"discounted_cash":1747.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878102 = Hospital System Supply Identifier | 876769 = Lawson ID"}]},{"description":"O-PLATE TI 24MM","code_information":[{"code":"Sx00-1015-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878103","type":"LOCAL"},{"code":"876770","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.0,"discounted_cash":1747.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878103 = Hospital System Supply Identifier | 876770 = Lawson ID"}]},{"description":"I-PLATE TI 16MM","code_information":[{"code":"Sx00-1015-841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878104","type":"LOCAL"},{"code":"876771","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.0,"discounted_cash":1747.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878104 = Hospital System Supply Identifier | 876771 = Lawson ID"}]},{"description":"I-PLATE TI 22MM","code_information":[{"code":"Sx00-1015-842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878105","type":"LOCAL"},{"code":"876772","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.0,"discounted_cash":1747.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878105 = Hospital System Supply Identifier | 876772 = Lawson ID"}]},{"description":"I-PLATE TI 32MM","code_information":[{"code":"Sx00-1015-843","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878106","type":"LOCAL"},{"code":"876773","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.0,"discounted_cash":1747.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878106 = Hospital System Supply Identifier | 876773 = Lawson ID"}]},{"description":"WASHER","code_information":[{"code":"Sx00-1030-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878107","type":"LOCAL"},{"code":"876774","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878107 = Hospital System Supply Identifier | 876774 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X30MM","code_information":[{"code":"Sx00-1030-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878108","type":"LOCAL"},{"code":"876775","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878108 = Hospital System Supply Identifier | 876775 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X32MM","code_information":[{"code":"Sx00-1030-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878109","type":"LOCAL"},{"code":"876776","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878109 = Hospital System Supply Identifier | 876776 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X34MM","code_information":[{"code":"Sx00-1030-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878110","type":"LOCAL"},{"code":"876777","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878110 = Hospital System Supply Identifier | 876777 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X36MM","code_information":[{"code":"Sx00-1030-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878111","type":"LOCAL"},{"code":"876778","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878111 = Hospital System Supply Identifier | 876778 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X38MM","code_information":[{"code":"Sx00-1030-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878112","type":"LOCAL"},{"code":"876779","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878112 = Hospital System Supply Identifier | 876779 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X40MM","code_information":[{"code":"Sx00-1030-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878113","type":"LOCAL"},{"code":"876780","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878113 = Hospital System Supply Identifier | 876780 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X42MM","code_information":[{"code":"Sx00-1030-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878114","type":"LOCAL"},{"code":"876781","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878114 = Hospital System Supply Identifier | 876781 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X44MM","code_information":[{"code":"Sx00-1030-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878115","type":"LOCAL"},{"code":"876782","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878115 = Hospital System Supply Identifier | 876782 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X46MM","code_information":[{"code":"Sx00-1030-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878116","type":"LOCAL"},{"code":"876783","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878116 = Hospital System Supply Identifier | 876783 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X48MM","code_information":[{"code":"Sx00-1030-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878117","type":"LOCAL"},{"code":"876784","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878117 = Hospital System Supply Identifier | 876784 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X50MM","code_information":[{"code":"Sx00-1030-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878118","type":"LOCAL"},{"code":"876785","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878118 = Hospital System Supply Identifier | 876785 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X52MM","code_information":[{"code":"Sx00-1030-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878119","type":"LOCAL"},{"code":"876786","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878119 = Hospital System Supply Identifier | 876786 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X54MM","code_information":[{"code":"Sx00-1030-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878120","type":"LOCAL"},{"code":"876787","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878120 = Hospital System Supply Identifier | 876787 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X56MM","code_information":[{"code":"Sx00-1030-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878121","type":"LOCAL"},{"code":"876788","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878121 = Hospital System Supply Identifier | 876788 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X58MM","code_information":[{"code":"Sx00-1030-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878122","type":"LOCAL"},{"code":"876789","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878122 = Hospital System Supply Identifier | 876789 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X60MM","code_information":[{"code":"Sx00-1030-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878123","type":"LOCAL"},{"code":"876790","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878123 = Hospital System Supply Identifier | 876790 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X65MM","code_information":[{"code":"Sx00-1030-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878124","type":"LOCAL"},{"code":"876791","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878124 = Hospital System Supply Identifier | 876791 = Lawson ID"}]},{"description":"SCREW MED THRD SS 4.0X70MM","code_information":[{"code":"Sx00-1030-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878125","type":"LOCAL"},{"code":"876792","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878125 = Hospital System Supply Identifier | 876792 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X20MM","code_information":[{"code":"Sx00-1030-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878126","type":"LOCAL"},{"code":"876793","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878126 = Hospital System Supply Identifier | 876793 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X22MM","code_information":[{"code":"Sx00-1030-122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878127","type":"LOCAL"},{"code":"876794","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878127 = Hospital System Supply Identifier | 876794 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X24MM","code_information":[{"code":"Sx00-1030-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878128","type":"LOCAL"},{"code":"876795","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878128 = Hospital System Supply Identifier | 876795 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X26MM","code_information":[{"code":"Sx00-1030-126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878129","type":"LOCAL"},{"code":"876796","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878129 = Hospital System Supply Identifier | 876796 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X28MM","code_information":[{"code":"Sx00-1030-128","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878130","type":"LOCAL"},{"code":"876797","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878130 = Hospital System Supply Identifier | 876797 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X30MM","code_information":[{"code":"Sx00-1030-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878131","type":"LOCAL"},{"code":"876798","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878131 = Hospital System Supply Identifier | 876798 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X35MM","code_information":[{"code":"Sx00-1030-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878132","type":"LOCAL"},{"code":"876799","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878132 = Hospital System Supply Identifier | 876799 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X40MM","code_information":[{"code":"Sx00-1030-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878133","type":"LOCAL"},{"code":"876800","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878133 = Hospital System Supply Identifier | 876800 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X45MM","code_information":[{"code":"Sx00-1030-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878134","type":"LOCAL"},{"code":"876801","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878134 = Hospital System Supply Identifier | 876801 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X50MM","code_information":[{"code":"Sx00-1030-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878135","type":"LOCAL"},{"code":"876802","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878135 = Hospital System Supply Identifier | 876802 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X55MM","code_information":[{"code":"Sx00-1030-155","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878136","type":"LOCAL"},{"code":"876803","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878136 = Hospital System Supply Identifier | 876803 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X60MM","code_information":[{"code":"Sx00-1030-160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878137","type":"LOCAL"},{"code":"876804","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878137 = Hospital System Supply Identifier | 876804 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X65MM","code_information":[{"code":"Sx00-1030-165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878138","type":"LOCAL"},{"code":"876805","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878138 = Hospital System Supply Identifier | 876805 = Lawson ID"}]},{"description":"SCREW FULL THRD SS 4.0X70MM","code_information":[{"code":"Sx00-1030-170","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878139","type":"LOCAL"},{"code":"876806","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878139 = Hospital System Supply Identifier | 876806 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X10MM","code_information":[{"code":"Sx00-1030-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878140","type":"LOCAL"},{"code":"876807","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878140 = Hospital System Supply Identifier | 876807 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X12MM","code_information":[{"code":"Sx00-1030-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878141","type":"LOCAL"},{"code":"876808","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878141 = Hospital System Supply Identifier | 876808 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X14MM","code_information":[{"code":"Sx00-1030-214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878142","type":"LOCAL"},{"code":"876809","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878142 = Hospital System Supply Identifier | 876809 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X16MM","code_information":[{"code":"Sx00-1030-216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878143","type":"LOCAL"},{"code":"876810","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878143 = Hospital System Supply Identifier | 876810 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X18MM","code_information":[{"code":"Sx00-1030-218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878144","type":"LOCAL"},{"code":"876811","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878144 = Hospital System Supply Identifier | 876811 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X20MM","code_information":[{"code":"Sx00-1030-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878145","type":"LOCAL"},{"code":"876812","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878145 = Hospital System Supply Identifier | 876812 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X22MM","code_information":[{"code":"Sx00-1030-222","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878146","type":"LOCAL"},{"code":"876813","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878146 = Hospital System Supply Identifier | 876813 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X24MM","code_information":[{"code":"Sx00-1030-224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878147","type":"LOCAL"},{"code":"876814","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878147 = Hospital System Supply Identifier | 876814 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X26MM","code_information":[{"code":"Sx00-1030-226","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878148","type":"LOCAL"},{"code":"876815","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878148 = Hospital System Supply Identifier | 876815 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X28MM","code_information":[{"code":"Sx00-1030-228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878149","type":"LOCAL"},{"code":"876816","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878149 = Hospital System Supply Identifier | 876816 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X30MM","code_information":[{"code":"Sx00-1030-230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878150","type":"LOCAL"},{"code":"876817","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878150 = Hospital System Supply Identifier | 876817 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X32MM","code_information":[{"code":"Sx00-1030-232","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878151","type":"LOCAL"},{"code":"876818","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878151 = Hospital System Supply Identifier | 876818 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X34MM","code_information":[{"code":"Sx00-1030-234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878152","type":"LOCAL"},{"code":"876819","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878152 = Hospital System Supply Identifier | 876819 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X36MM","code_information":[{"code":"Sx00-1030-236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878153","type":"LOCAL"},{"code":"876820","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878153 = Hospital System Supply Identifier | 876820 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X38MM","code_information":[{"code":"Sx00-1030-238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878154","type":"LOCAL"},{"code":"876821","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878154 = Hospital System Supply Identifier | 876821 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X40MM","code_information":[{"code":"Sx00-1030-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878155","type":"LOCAL"},{"code":"876822","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878155 = Hospital System Supply Identifier | 876822 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X42MM","code_information":[{"code":"Sx00-1030-242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878156","type":"LOCAL"},{"code":"876823","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878156 = Hospital System Supply Identifier | 876823 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X44MM","code_information":[{"code":"Sx00-1030-244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878157","type":"LOCAL"},{"code":"876824","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878157 = Hospital System Supply Identifier | 876824 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X46MM","code_information":[{"code":"Sx00-1030-246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878158","type":"LOCAL"},{"code":"876825","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878158 = Hospital System Supply Identifier | 876825 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X48MM","code_information":[{"code":"Sx00-1030-248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878159","type":"LOCAL"},{"code":"876826","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878159 = Hospital System Supply Identifier | 876826 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X50MM","code_information":[{"code":"Sx00-1030-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878160","type":"LOCAL"},{"code":"876827","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878160 = Hospital System Supply Identifier | 876827 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X52MM","code_information":[{"code":"Sx00-1030-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878161","type":"LOCAL"},{"code":"876828","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878161 = Hospital System Supply Identifier | 876828 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X54MM","code_information":[{"code":"Sx00-1030-254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878162","type":"LOCAL"},{"code":"876829","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878162 = Hospital System Supply Identifier | 876829 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X56MM","code_information":[{"code":"Sx00-1030-256","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878163","type":"LOCAL"},{"code":"876830","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878163 = Hospital System Supply Identifier | 876830 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X58MM","code_information":[{"code":"Sx00-1030-258","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878164","type":"LOCAL"},{"code":"876831","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878164 = Hospital System Supply Identifier | 876831 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X60MM","code_information":[{"code":"Sx00-1030-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878165","type":"LOCAL"},{"code":"876832","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878165 = Hospital System Supply Identifier | 876832 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X65MM","code_information":[{"code":"Sx00-1030-265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878166","type":"LOCAL"},{"code":"876833","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878166 = Hospital System Supply Identifier | 876833 = Lawson ID"}]},{"description":"SCREW SHRT THRD SS 4.0X70MM","code_information":[{"code":"Sx00-1030-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878167","type":"LOCAL"},{"code":"876834","type":"LOCAL"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":682.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878167 = Hospital System Supply Identifier | 876834 = Lawson ID"}]},{"description":"PLATE KLS GRIFFIN 03MM","code_information":[{"code":"Sx00-104-19-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"360643","type":"LOCAL"},{"code":"144792","type":"LOCAL"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 360643 = Hospital System Supply Identifier | 144792 = Lawson ID"}]},{"description":"PLATE KLS GRIFFIN 05MM","code_information":[{"code":"Sx00-104-20-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"360644","type":"LOCAL"},{"code":"144793","type":"LOCAL"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 360644 = Hospital System Supply Identifier | 144793 = Lawson ID"}]},{"description":"PLATE KLS GRIFFIN 07MM","code_information":[{"code":"Sx00-104-21-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"360645","type":"LOCAL"},{"code":"144794","type":"LOCAL"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 360645 = Hospital System Supply Identifier | 144794 = Lawson ID"}]},{"description":"PLATE CHIN GRIFFIN 9MM ADV","code_information":[{"code":"Sx00-104-22-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"360673","type":"LOCAL"},{"code":"232039","type":"LOCAL"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 360673 = Hospital System Supply Identifier | 232039 = Lawson ID"}]},{"description":"PLATE LVL1 ORTHOG GRIFFIN","code_information":[{"code":"Sx00-104-23-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"650090","type":"LOCAL"},{"code":"723561","type":"LOCAL"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 650090 = Hospital System Supply Identifier | 723561 = Lawson ID"}]},{"description":"DRILL TWIST MIDAS REX 1.0 X5MM","code_information":[{"code":"Sx00-104-49-0","type":"CDM"},{"code":"272","type":"RC"},{"code":"646764","type":"LOCAL"},{"code":"310249","type":"LOCAL"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 646764 = Hospital System Supply Identifier | 310249 = Lawson ID"}]},{"description":"MESH L1 STD ORTHOG STRIP 117MM","code_information":[{"code":"Sx00-105-49-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"743220","type":"LOCAL"},{"code":"773377","type":"LOCAL"}],"standard_charges":[{"gross_charge":1382.36,"discounted_cash":967.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 743220 = Hospital System Supply Identifier | 773377 = Lawson ID"}]},{"description":"PLATE LVL1 MINI BAYS T-SHP 4HL","code_information":[{"code":"Sx00-105-59-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"650222","type":"LOCAL"},{"code":"723693","type":"LOCAL"}],"standard_charges":[{"gross_charge":635.75,"discounted_cash":445.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 650222 = Hospital System Supply Identifier | 723693 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 8H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934256","type":"LOCAL"},{"code":"414030","type":"LOCAL"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934256 = Hospital System Supply Identifier | 414030 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 7H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934255","type":"LOCAL"},{"code":"414029","type":"LOCAL"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":507.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934255 = Hospital System Supply Identifier | 414029 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 4H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934252","type":"LOCAL"},{"code":"414027","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934252 = Hospital System Supply Identifier | 414027 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 5H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934253","type":"LOCAL"},{"code":"414028","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934253 = Hospital System Supply Identifier | 414028 = Lawson ID"}]},{"description":"PLATE LOK TBLR 1/3 6H","code_information":[{"code":"Sx00-1050-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934254","type":"LOCAL"},{"code":"410079","type":"LOCAL"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934254 = Hospital System Supply Identifier | 410079 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 LOK 10H","code_information":[{"code":"Sx00-1050-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934257","type":"LOCAL"},{"code":"414031","type":"LOCAL"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":542.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934257 = Hospital System Supply Identifier | 414031 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 4H","code_information":[{"code":"Sx00-1050-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934258","type":"LOCAL"},{"code":"414032","type":"LOCAL"}],"standard_charges":[{"gross_charge":1290.0,"discounted_cash":903.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934258 = Hospital System Supply Identifier | 414032 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 6H","code_information":[{"code":"Sx00-1050-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934259","type":"LOCAL"},{"code":"414033","type":"LOCAL"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":978.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934259 = Hospital System Supply Identifier | 414033 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 8H","code_information":[{"code":"Sx00-1050-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934260","type":"LOCAL"},{"code":"414034","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934260 = Hospital System Supply Identifier | 414034 = Lawson ID"}]},{"description":"PLATE PED COMPR LOK FEM 10H","code_information":[{"code":"Sx00-1050-221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934261","type":"LOCAL"},{"code":"414035","type":"LOCAL"}],"standard_charges":[{"gross_charge":1290.0,"discounted_cash":903.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934261 = Hospital System Supply Identifier | 414035 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 8H RT","code_information":[{"code":"Sx00-1050-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934262","type":"LOCAL"},{"code":"414194","type":"LOCAL"}],"standard_charges":[{"gross_charge":9666.58,"discounted_cash":6766.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934262 = Hospital System Supply Identifier | 414194 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 6H RT","code_information":[{"code":"Sx00-1050-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"586789","type":"LOCAL"},{"code":"414193","type":"LOCAL"}],"standard_charges":[{"gross_charge":9666.58,"discounted_cash":6766.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 586789 = Hospital System Supply Identifier | 414193 = Lawson ID"}]},{"description":"IMPLANT-PLATE-BONE COMPRESSION LOCKING FEMORAL TITANIUM 18-HOLE","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176685","type":"LOCAL"},{"code":"1083572","type":"LOCAL"}],"standard_charges":[{"gross_charge":11362.95,"discounted_cash":7954.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176685 = Hospital System Supply Identifier | 1083572 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 10H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934263","type":"LOCAL"},{"code":"410080","type":"LOCAL"}],"standard_charges":[{"gross_charge":9684.16,"discounted_cash":6778.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934263 = Hospital System Supply Identifier | 410080 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 12H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934264","type":"LOCAL"},{"code":"414036","type":"LOCAL"}],"standard_charges":[{"gross_charge":9902.18,"discounted_cash":6931.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934264 = Hospital System Supply Identifier | 414036 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 14H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934265","type":"LOCAL"},{"code":"414037","type":"LOCAL"}],"standard_charges":[{"gross_charge":10120.19,"discounted_cash":7084.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934265 = Hospital System Supply Identifier | 414037 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 16H RT","code_information":[{"code":"Sx00-1050-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934266","type":"LOCAL"},{"code":"414038","type":"LOCAL"}],"standard_charges":[{"gross_charge":11362.95,"discounted_cash":7954.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934266 = Hospital System Supply Identifier | 414038 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 6H LT","code_information":[{"code":"Sx00-1050-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"586050","type":"LOCAL"},{"code":"410081","type":"LOCAL"}],"standard_charges":[{"gross_charge":9666.58,"discounted_cash":6766.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 586050 = Hospital System Supply Identifier | 410081 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 8H LT","code_information":[{"code":"Sx00-1050-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934267","type":"LOCAL"},{"code":"410082","type":"LOCAL"}],"standard_charges":[{"gross_charge":9666.58,"discounted_cash":6766.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934267 = Hospital System Supply Identifier | 410082 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 16H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934271","type":"LOCAL"},{"code":"414043","type":"LOCAL"}],"standard_charges":[{"gross_charge":11362.95,"discounted_cash":7954.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934271 = Hospital System Supply Identifier | 414043 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 14H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934270","type":"LOCAL"},{"code":"414042","type":"LOCAL"}],"standard_charges":[{"gross_charge":10120.19,"discounted_cash":7084.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934270 = Hospital System Supply Identifier | 414042 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 12H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934269","type":"LOCAL"},{"code":"414041","type":"LOCAL"}],"standard_charges":[{"gross_charge":9902.18,"discounted_cash":6931.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934269 = Hospital System Supply Identifier | 414041 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5 10H LT","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934268","type":"LOCAL"},{"code":"414040","type":"LOCAL"}],"standard_charges":[{"gross_charge":9684.16,"discounted_cash":6778.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934268 = Hospital System Supply Identifier | 414040 = Lawson ID"}]},{"description":"PLATE BONE COMPRESSION LOCKING 18 HOLE PEDILOC 0010503118 3.5MM","code_information":[{"code":"Sx00-1050-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175887","type":"LOCAL"},{"code":"1083743","type":"LOCAL"}],"standard_charges":[{"gross_charge":11362.95,"discounted_cash":7954.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175887 = Hospital System Supply Identifier | 1083743 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 14H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934274","type":"LOCAL"},{"code":"410083","type":"LOCAL"}],"standard_charges":[{"gross_charge":7415.85,"discounted_cash":5191.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934274 = Hospital System Supply Identifier | 410083 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 10H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934272","type":"LOCAL"},{"code":"414045","type":"LOCAL"}],"standard_charges":[{"gross_charge":6668.6,"discounted_cash":4668.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934272 = Hospital System Supply Identifier | 414045 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 12H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934273","type":"LOCAL"},{"code":"414046","type":"LOCAL"}],"standard_charges":[{"gross_charge":6884.87,"discounted_cash":4819.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934273 = Hospital System Supply Identifier | 414046 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 16H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934275","type":"LOCAL"},{"code":"414047","type":"LOCAL"}],"standard_charges":[{"gross_charge":8698.35,"discounted_cash":6088.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934275 = Hospital System Supply Identifier | 414047 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 3.5MM 18H","code_information":[{"code":"Sx00-1050-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934276","type":"LOCAL"},{"code":"414048","type":"LOCAL"}],"standard_charges":[{"gross_charge":8978.95,"discounted_cash":6285.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934276 = Hospital System Supply Identifier | 414048 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 8H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934282","type":"LOCAL"},{"code":"414053","type":"LOCAL"}],"standard_charges":[{"gross_charge":539.3,"discounted_cash":377.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934282 = Hospital System Supply Identifier | 414053 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 7H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934281","type":"LOCAL"},{"code":"414052","type":"LOCAL"}],"standard_charges":[{"gross_charge":539.3,"discounted_cash":377.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934281 = Hospital System Supply Identifier | 414052 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 5H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934279","type":"LOCAL"},{"code":"414050","type":"LOCAL"}],"standard_charges":[{"gross_charge":517.9,"discounted_cash":362.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934279 = Hospital System Supply Identifier | 414050 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 4H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934278","type":"LOCAL"},{"code":"414049","type":"LOCAL"}],"standard_charges":[{"gross_charge":496.5,"discounted_cash":347.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934278 = Hospital System Supply Identifier | 414049 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 6H","code_information":[{"code":"Sx00-1050-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934280","type":"LOCAL"},{"code":"414051","type":"LOCAL"}],"standard_charges":[{"gross_charge":517.9,"discounted_cash":362.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934280 = Hospital System Supply Identifier | 414051 = Lawson ID"}]},{"description":"PLATE PED TBLR 1/3 N-LOK 10H","code_information":[{"code":"Sx00-1050-341","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934283","type":"LOCAL"},{"code":"414054","type":"LOCAL"}],"standard_charges":[{"gross_charge":614.85,"discounted_cash":430.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934283 = Hospital System Supply Identifier | 414054 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X12","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934285","type":"LOCAL"},{"code":"414056","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934285 = Hospital System Supply Identifier | 414056 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X16","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934287","type":"LOCAL"},{"code":"402528","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934287 = Hospital System Supply Identifier | 402528 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X18","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934288","type":"LOCAL"},{"code":"402529","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934288 = Hospital System Supply Identifier | 402529 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X10","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934284","type":"LOCAL"},{"code":"414055","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934284 = Hospital System Supply Identifier | 414055 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X14","code_information":[{"code":"Sx00-1050-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934286","type":"LOCAL"},{"code":"414057","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934286 = Hospital System Supply Identifier | 414057 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X28","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934294","type":"LOCAL"},{"code":"399824","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934294 = Hospital System Supply Identifier | 399824 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X26","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934293","type":"LOCAL"},{"code":"399823","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934293 = Hospital System Supply Identifier | 399823 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X24","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934292","type":"LOCAL"},{"code":"399822","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934292 = Hospital System Supply Identifier | 399822 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X22","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934291","type":"LOCAL"},{"code":"399821","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934291 = Hospital System Supply Identifier | 399821 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X20","code_information":[{"code":"Sx00-1050-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934290","type":"LOCAL"},{"code":"399820","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934290 = Hospital System Supply Identifier | 399820 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X30","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934295","type":"LOCAL"},{"code":"399825","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934295 = Hospital System Supply Identifier | 399825 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X32","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934296","type":"LOCAL"},{"code":"399826","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934296 = Hospital System Supply Identifier | 399826 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X34","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934297","type":"LOCAL"},{"code":"399827","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934297 = Hospital System Supply Identifier | 399827 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X36","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934298","type":"LOCAL"},{"code":"399828","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934298 = Hospital System Supply Identifier | 399828 = Lawson ID"}]},{"description":"SCREW CORT NLOK FT 3.5X38MM","code_information":[{"code":"Sx00-1050-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934299","type":"LOCAL"},{"code":"431449","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934299 = Hospital System Supply Identifier | 431449 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X46","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934303","type":"LOCAL"},{"code":"414061","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934303 = Hospital System Supply Identifier | 414061 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X42","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934301","type":"LOCAL"},{"code":"414059","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934301 = Hospital System Supply Identifier | 414059 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X44","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934302","type":"LOCAL"},{"code":"414060","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934302 = Hospital System Supply Identifier | 414060 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X48","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585334","type":"LOCAL"},{"code":"399829","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585334 = Hospital System Supply Identifier | 399829 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X40","code_information":[{"code":"Sx00-1050-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934300","type":"LOCAL"},{"code":"414058","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934300 = Hospital System Supply Identifier | 414058 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X50","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934304","type":"LOCAL"},{"code":"414062","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934304 = Hospital System Supply Identifier | 414062 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X52","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934305","type":"LOCAL"},{"code":"414063","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934305 = Hospital System Supply Identifier | 414063 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X54","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934306","type":"LOCAL"},{"code":"414064","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934306 = Hospital System Supply Identifier | 414064 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X56","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934307","type":"LOCAL"},{"code":"414065","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934307 = Hospital System Supply Identifier | 414065 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X58","code_information":[{"code":"Sx00-1050-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934308","type":"LOCAL"},{"code":"414066","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934308 = Hospital System Supply Identifier | 414066 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X60","code_information":[{"code":"Sx00-1050-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934309","type":"LOCAL"},{"code":"414067","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934309 = Hospital System Supply Identifier | 414067 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X65","code_information":[{"code":"Sx00-1050-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934310","type":"LOCAL"},{"code":"414068","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934310 = Hospital System Supply Identifier | 414068 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 3.5X70","code_information":[{"code":"Sx00-1050-357","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934311","type":"LOCAL"},{"code":"414069","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934311 = Hospital System Supply Identifier | 414069 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X14MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934314","type":"LOCAL"},{"code":"414071","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934314 = Hospital System Supply Identifier | 414071 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X10MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934312","type":"LOCAL"},{"code":"414070","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934312 = Hospital System Supply Identifier | 414070 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X12MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934313","type":"LOCAL"},{"code":"399830","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934313 = Hospital System Supply Identifier | 399830 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X16MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585335","type":"LOCAL"},{"code":"399831","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585335 = Hospital System Supply Identifier | 399831 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X18MM","code_information":[{"code":"Sx00-1050-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934315","type":"LOCAL"},{"code":"399832","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934315 = Hospital System Supply Identifier | 399832 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X20MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934316","type":"LOCAL"},{"code":"399833","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934316 = Hospital System Supply Identifier | 399833 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X22MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934317","type":"LOCAL"},{"code":"399834","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934317 = Hospital System Supply Identifier | 399834 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X24MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585336","type":"LOCAL"},{"code":"399835","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585336 = Hospital System Supply Identifier | 399835 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X26MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585337","type":"LOCAL"},{"code":"399836","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585337 = Hospital System Supply Identifier | 399836 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X28MM","code_information":[{"code":"Sx00-1050-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934318","type":"LOCAL"},{"code":"399837","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934318 = Hospital System Supply Identifier | 399837 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X38MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"586785","type":"LOCAL"},{"code":"414072","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 586785 = Hospital System Supply Identifier | 414072 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X36MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934321","type":"LOCAL"},{"code":"399841","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934321 = Hospital System Supply Identifier | 399841 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X34MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585338","type":"LOCAL"},{"code":"399840","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585338 = Hospital System Supply Identifier | 399840 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X30MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934319","type":"LOCAL"},{"code":"399838","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934319 = Hospital System Supply Identifier | 399838 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X32MM","code_information":[{"code":"Sx00-1050-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934320","type":"LOCAL"},{"code":"399839","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934320 = Hospital System Supply Identifier | 399839 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X40MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934322","type":"LOCAL"},{"code":"399842","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934322 = Hospital System Supply Identifier | 399842 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X42MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934323","type":"LOCAL"},{"code":"399843","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934323 = Hospital System Supply Identifier | 399843 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X44MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"585339","type":"LOCAL"},{"code":"399844","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 585339 = Hospital System Supply Identifier | 399844 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X46MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934324","type":"LOCAL"},{"code":"399845","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934324 = Hospital System Supply Identifier | 399845 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X48MM","code_information":[{"code":"Sx00-1050-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934325","type":"LOCAL"},{"code":"399846","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934325 = Hospital System Supply Identifier | 399846 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X56MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"586788","type":"LOCAL"},{"code":"414075","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 586788 = Hospital System Supply Identifier | 414075 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X54MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"586787","type":"LOCAL"},{"code":"414074","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 586787 = Hospital System Supply Identifier | 414074 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X52MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934326","type":"LOCAL"},{"code":"399847","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934326 = Hospital System Supply Identifier | 399847 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X58MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934328","type":"LOCAL"},{"code":"399848","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934328 = Hospital System Supply Identifier | 399848 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X50MM","code_information":[{"code":"Sx00-1050-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"586786","type":"LOCAL"},{"code":"414073","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 586786 = Hospital System Supply Identifier | 414073 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X60MM","code_information":[{"code":"Sx00-1050-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934329","type":"LOCAL"},{"code":"414076","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934329 = Hospital System Supply Identifier | 414076 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X65MM","code_information":[{"code":"Sx00-1050-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934330","type":"LOCAL"},{"code":"414077","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934330 = Hospital System Supply Identifier | 414077 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 3.5X70MM","code_information":[{"code":"Sx00-1050-367","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934331","type":"LOCAL"},{"code":"414078","type":"LOCAL"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":472.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934331 = Hospital System Supply Identifier | 414078 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X18","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934336","type":"LOCAL"},{"code":"414083","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934336 = Hospital System Supply Identifier | 414083 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X14","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934334","type":"LOCAL"},{"code":"414081","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934334 = Hospital System Supply Identifier | 414081 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X16","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934335","type":"LOCAL"},{"code":"414082","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934335 = Hospital System Supply Identifier | 414082 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X10","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934332","type":"LOCAL"},{"code":"414079","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934332 = Hospital System Supply Identifier | 414079 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X12","code_information":[{"code":"Sx00-1050-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934333","type":"LOCAL"},{"code":"414080","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934333 = Hospital System Supply Identifier | 414080 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X20","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934337","type":"LOCAL"},{"code":"414084","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934337 = Hospital System Supply Identifier | 414084 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X22","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934338","type":"LOCAL"},{"code":"414085","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934338 = Hospital System Supply Identifier | 414085 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X24","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934339","type":"LOCAL"},{"code":"414086","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934339 = Hospital System Supply Identifier | 414086 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X26","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934340","type":"LOCAL"},{"code":"414087","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934340 = Hospital System Supply Identifier | 414087 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X28","code_information":[{"code":"Sx00-1050-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934342","type":"LOCAL"},{"code":"414088","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934342 = Hospital System Supply Identifier | 414088 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X38","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934347","type":"LOCAL"},{"code":"414093","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934347 = Hospital System Supply Identifier | 414093 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X34","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934345","type":"LOCAL"},{"code":"414091","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934345 = Hospital System Supply Identifier | 414091 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X36","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934346","type":"LOCAL"},{"code":"414092","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934346 = Hospital System Supply Identifier | 414092 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X30","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934343","type":"LOCAL"},{"code":"414089","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934343 = Hospital System Supply Identifier | 414089 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X32","code_information":[{"code":"Sx00-1050-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934344","type":"LOCAL"},{"code":"414090","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934344 = Hospital System Supply Identifier | 414090 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X40","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934348","type":"LOCAL"},{"code":"414094","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934348 = Hospital System Supply Identifier | 414094 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X42","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934350","type":"LOCAL"},{"code":"414095","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934350 = Hospital System Supply Identifier | 414095 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X44","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934351","type":"LOCAL"},{"code":"414096","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934351 = Hospital System Supply Identifier | 414096 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X46","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934352","type":"LOCAL"},{"code":"414097","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934352 = Hospital System Supply Identifier | 414097 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X48","code_information":[{"code":"Sx00-1050-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934353","type":"LOCAL"},{"code":"414098","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934353 = Hospital System Supply Identifier | 414098 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X58","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934360","type":"LOCAL"},{"code":"414103","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934360 = Hospital System Supply Identifier | 414103 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X56","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934359","type":"LOCAL"},{"code":"414102","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934359 = Hospital System Supply Identifier | 414102 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X54","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934358","type":"LOCAL"},{"code":"414101","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934358 = Hospital System Supply Identifier | 414101 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X50","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934354","type":"LOCAL"},{"code":"414099","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934354 = Hospital System Supply Identifier | 414099 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X52","code_information":[{"code":"Sx00-1050-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934357","type":"LOCAL"},{"code":"414100","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934357 = Hospital System Supply Identifier | 414100 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK F/T 4X60","code_information":[{"code":"Sx00-1050-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934361","type":"LOCAL"},{"code":"414104","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934361 = Hospital System Supply Identifier | 414104 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X10","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934362","type":"LOCAL"},{"code":"414105","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934362 = Hospital System Supply Identifier | 414105 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X12","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934363","type":"LOCAL"},{"code":"414106","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934363 = Hospital System Supply Identifier | 414106 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X14","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934364","type":"LOCAL"},{"code":"414107","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934364 = Hospital System Supply Identifier | 414107 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X16","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934365","type":"LOCAL"},{"code":"414108","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934365 = Hospital System Supply Identifier | 414108 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X18","code_information":[{"code":"Sx00-1050-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934366","type":"LOCAL"},{"code":"414109","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934366 = Hospital System Supply Identifier | 414109 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X26","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934370","type":"LOCAL"},{"code":"414113","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934370 = Hospital System Supply Identifier | 414113 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X24","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934369","type":"LOCAL"},{"code":"414112","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934369 = Hospital System Supply Identifier | 414112 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X28","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934371","type":"LOCAL"},{"code":"414114","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934371 = Hospital System Supply Identifier | 414114 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X20","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934367","type":"LOCAL"},{"code":"414110","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934367 = Hospital System Supply Identifier | 414110 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X22","code_information":[{"code":"Sx00-1050-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934368","type":"LOCAL"},{"code":"414111","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934368 = Hospital System Supply Identifier | 414111 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X30","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934372","type":"LOCAL"},{"code":"414115","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934372 = Hospital System Supply Identifier | 414115 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X32","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934373","type":"LOCAL"},{"code":"414116","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934373 = Hospital System Supply Identifier | 414116 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X34","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934374","type":"LOCAL"},{"code":"414117","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934374 = Hospital System Supply Identifier | 414117 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X36","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934375","type":"LOCAL"},{"code":"414118","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934375 = Hospital System Supply Identifier | 414118 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X38","code_information":[{"code":"Sx00-1050-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934376","type":"LOCAL"},{"code":"414119","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934376 = Hospital System Supply Identifier | 414119 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X48","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934382","type":"LOCAL"},{"code":"414124","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934382 = Hospital System Supply Identifier | 414124 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X44","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934380","type":"LOCAL"},{"code":"414122","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934380 = Hospital System Supply Identifier | 414122 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X46","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934381","type":"LOCAL"},{"code":"414123","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934381 = Hospital System Supply Identifier | 414123 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X40","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934378","type":"LOCAL"},{"code":"414120","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934378 = Hospital System Supply Identifier | 414120 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X42","code_information":[{"code":"Sx00-1050-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934379","type":"LOCAL"},{"code":"414121","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934379 = Hospital System Supply Identifier | 414121 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X50","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934383","type":"LOCAL"},{"code":"414125","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934383 = Hospital System Supply Identifier | 414125 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X52","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934384","type":"LOCAL"},{"code":"414126","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934384 = Hospital System Supply Identifier | 414126 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X54","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934385","type":"LOCAL"},{"code":"414127","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934385 = Hospital System Supply Identifier | 414127 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X56","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934386","type":"LOCAL"},{"code":"414128","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934386 = Hospital System Supply Identifier | 414128 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X58","code_information":[{"code":"Sx00-1050-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934387","type":"LOCAL"},{"code":"414129","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934387 = Hospital System Supply Identifier | 414129 = Lawson ID"}]},{"description":"SCREW PED CANC N-LOK P/T 4X60","code_information":[{"code":"Sx00-1050-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934388","type":"LOCAL"},{"code":"414130","type":"LOCAL"}],"standard_charges":[{"gross_charge":237.5,"discounted_cash":166.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934388 = Hospital System Supply Identifier | 414130 = Lawson ID"}]},{"description":"PLATE PEDI COMP FEM 4.5MM 6H","code_information":[{"code":"Sx00-1050-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934389","type":"LOCAL"},{"code":"410084","type":"LOCAL"}],"standard_charges":[{"gross_charge":11115.95,"discounted_cash":7781.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934389 = Hospital System Supply Identifier | 410084 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.52 8H RT","code_information":[{"code":"Sx00-1050-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934390","type":"LOCAL"},{"code":"414131","type":"LOCAL"}],"standard_charges":[{"gross_charge":11115.95,"discounted_cash":7781.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934390 = Hospital System Supply Identifier | 414131 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 18H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934395","type":"LOCAL"},{"code":"414136","type":"LOCAL"}],"standard_charges":[{"gross_charge":12540.09,"discounted_cash":8778.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934395 = Hospital System Supply Identifier | 414136 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 16H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934394","type":"LOCAL"},{"code":"414135","type":"LOCAL"}],"standard_charges":[{"gross_charge":11603.41,"discounted_cash":8122.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934394 = Hospital System Supply Identifier | 414135 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 10H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934391","type":"LOCAL"},{"code":"414132","type":"LOCAL"}],"standard_charges":[{"gross_charge":11115.95,"discounted_cash":7781.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934391 = Hospital System Supply Identifier | 414132 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 12H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934392","type":"LOCAL"},{"code":"414133","type":"LOCAL"}],"standard_charges":[{"gross_charge":11115.95,"discounted_cash":7781.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934392 = Hospital System Supply Identifier | 414133 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 14H RT","code_information":[{"code":"Sx00-1050-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934393","type":"LOCAL"},{"code":"414134","type":"LOCAL"}],"standard_charges":[{"gross_charge":11367.64,"discounted_cash":7957.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934393 = Hospital System Supply Identifier | 414134 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 20H RT","code_information":[{"code":"Sx00-1050-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934398","type":"LOCAL"},{"code":"414137","type":"LOCAL"}],"standard_charges":[{"gross_charge":13065.78,"discounted_cash":9146.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934398 = Hospital System Supply Identifier | 414137 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 6H LT","code_information":[{"code":"Sx00-1050-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934399","type":"LOCAL"},{"code":"414138","type":"LOCAL"}],"standard_charges":[{"gross_charge":11115.95,"discounted_cash":7781.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934399 = Hospital System Supply Identifier | 414138 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 8H LT","code_information":[{"code":"Sx00-1050-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934400","type":"LOCAL"},{"code":"414139","type":"LOCAL"}],"standard_charges":[{"gross_charge":11115.95,"discounted_cash":7781.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934400 = Hospital System Supply Identifier | 414139 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 18H LT","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934405","type":"LOCAL"},{"code":"414142","type":"LOCAL"}],"standard_charges":[{"gross_charge":12540.09,"discounted_cash":8778.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934405 = Hospital System Supply Identifier | 414142 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 10H LT","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934401","type":"LOCAL"},{"code":"414140","type":"LOCAL"}],"standard_charges":[{"gross_charge":11115.95,"discounted_cash":7781.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934401 = Hospital System Supply Identifier | 414140 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 12H LT","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934402","type":"LOCAL"},{"code":"414141","type":"LOCAL"}],"standard_charges":[{"gross_charge":11115.95,"discounted_cash":7781.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934402 = Hospital System Supply Identifier | 414141 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 14H","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934403","type":"LOCAL"},{"code":"410085","type":"LOCAL"}],"standard_charges":[{"gross_charge":11367.64,"discounted_cash":7957.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934403 = Hospital System Supply Identifier | 410085 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 16H","code_information":[{"code":"Sx00-1050-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934404","type":"LOCAL"},{"code":"410086","type":"LOCAL"}],"standard_charges":[{"gross_charge":11603.41,"discounted_cash":8122.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934404 = Hospital System Supply Identifier | 410086 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5 20H LT","code_information":[{"code":"Sx00-1050-432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934406","type":"LOCAL"},{"code":"414143","type":"LOCAL"}],"standard_charges":[{"gross_charge":13065.78,"discounted_cash":9146.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934406 = Hospital System Supply Identifier | 414143 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 10H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934407","type":"LOCAL"},{"code":"410087","type":"LOCAL"}],"standard_charges":[{"gross_charge":6884.87,"discounted_cash":4819.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934407 = Hospital System Supply Identifier | 410087 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 12H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934408","type":"LOCAL"},{"code":"414144","type":"LOCAL"}],"standard_charges":[{"gross_charge":7145.01,"discounted_cash":5001.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934408 = Hospital System Supply Identifier | 414144 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 14H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934409","type":"LOCAL"},{"code":"414145","type":"LOCAL"}],"standard_charges":[{"gross_charge":7526.26,"discounted_cash":5268.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934409 = Hospital System Supply Identifier | 414145 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 16H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934410","type":"LOCAL"},{"code":"414146","type":"LOCAL"}],"standard_charges":[{"gross_charge":8851.08,"discounted_cash":6195.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934410 = Hospital System Supply Identifier | 414146 = Lawson ID"}]},{"description":"PLATE COMPR LOK FEM 4.5MM 18H","code_information":[{"code":"Sx00-1050-441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934411","type":"LOCAL"},{"code":"414147","type":"LOCAL"}],"standard_charges":[{"gross_charge":9149.67,"discounted_cash":6404.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934411 = Hospital System Supply Identifier | 414147 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X18","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934416","type":"LOCAL"},{"code":"414152","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934416 = Hospital System Supply Identifier | 414152 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X16","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934415","type":"LOCAL"},{"code":"414151","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934415 = Hospital System Supply Identifier | 414151 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X14","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934414","type":"LOCAL"},{"code":"414150","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934414 = Hospital System Supply Identifier | 414150 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X12","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934413","type":"LOCAL"},{"code":"414149","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934413 = Hospital System Supply Identifier | 414149 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X10","code_information":[{"code":"Sx00-1050-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934412","type":"LOCAL"},{"code":"414148","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934412 = Hospital System Supply Identifier | 414148 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X22","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934418","type":"LOCAL"},{"code":"399849","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934418 = Hospital System Supply Identifier | 399849 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X26","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934420","type":"LOCAL"},{"code":"399850","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934420 = Hospital System Supply Identifier | 399850 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X20","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934417","type":"LOCAL"},{"code":"414153","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934417 = Hospital System Supply Identifier | 414153 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X24","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934419","type":"LOCAL"},{"code":"414154","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934419 = Hospital System Supply Identifier | 414154 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X28","code_information":[{"code":"Sx00-1050-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934421","type":"LOCAL"},{"code":"414155","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934421 = Hospital System Supply Identifier | 414155 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X38","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934426","type":"LOCAL"},{"code":"414159","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934426 = Hospital System Supply Identifier | 414159 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X36","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934425","type":"LOCAL"},{"code":"414158","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934425 = Hospital System Supply Identifier | 414158 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X34","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934424","type":"LOCAL"},{"code":"414157","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934424 = Hospital System Supply Identifier | 414157 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X30","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934422","type":"LOCAL"},{"code":"414156","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934422 = Hospital System Supply Identifier | 414156 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X32","code_information":[{"code":"Sx00-1050-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934423","type":"LOCAL"},{"code":"399851","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934423 = Hospital System Supply Identifier | 399851 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X42","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934428","type":"LOCAL"},{"code":"399852","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934428 = Hospital System Supply Identifier | 399852 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X44","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934429","type":"LOCAL"},{"code":"399853","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934429 = Hospital System Supply Identifier | 399853 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X48","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934431","type":"LOCAL"},{"code":"399854","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934431 = Hospital System Supply Identifier | 399854 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X40","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934427","type":"LOCAL"},{"code":"414160","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934427 = Hospital System Supply Identifier | 414160 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X46","code_information":[{"code":"Sx00-1050-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934430","type":"LOCAL"},{"code":"414161","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934430 = Hospital System Supply Identifier | 414161 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X58","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934437","type":"LOCAL"},{"code":"414164","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934437 = Hospital System Supply Identifier | 414164 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X50","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934432","type":"LOCAL"},{"code":"414162","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934432 = Hospital System Supply Identifier | 414162 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X56","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934435","type":"LOCAL"},{"code":"414163","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934435 = Hospital System Supply Identifier | 414163 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X52","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934433","type":"LOCAL"},{"code":"399855","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934433 = Hospital System Supply Identifier | 399855 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X54","code_information":[{"code":"Sx00-1050-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934434","type":"LOCAL"},{"code":"399856","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934434 = Hospital System Supply Identifier | 399856 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X60","code_information":[{"code":"Sx00-1050-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934438","type":"LOCAL"},{"code":"399857","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934438 = Hospital System Supply Identifier | 399857 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X65","code_information":[{"code":"Sx00-1050-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934439","type":"LOCAL"},{"code":"414165","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934439 = Hospital System Supply Identifier | 414165 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X70","code_information":[{"code":"Sx00-1050-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934440","type":"LOCAL"},{"code":"399858","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934440 = Hospital System Supply Identifier | 399858 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X75","code_information":[{"code":"Sx00-1050-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934441","type":"LOCAL"},{"code":"399859","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934441 = Hospital System Supply Identifier | 399859 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X80","code_information":[{"code":"Sx00-1050-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934442","type":"LOCAL"},{"code":"414166","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934442 = Hospital System Supply Identifier | 414166 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X85","code_information":[{"code":"Sx00-1050-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934443","type":"LOCAL"},{"code":"414167","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934443 = Hospital System Supply Identifier | 414167 = Lawson ID"}]},{"description":"SCREW PED CORT N-LOK FT 4.5X90","code_information":[{"code":"Sx00-1050-459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934444","type":"LOCAL"},{"code":"414168","type":"LOCAL"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":232.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934444 = Hospital System Supply Identifier | 414168 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X12","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934447","type":"LOCAL"},{"code":"414170","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934447 = Hospital System Supply Identifier | 414170 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X18","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934450","type":"LOCAL"},{"code":"414173","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934450 = Hospital System Supply Identifier | 414173 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X16","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934449","type":"LOCAL"},{"code":"414172","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934449 = Hospital System Supply Identifier | 414172 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X10","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934445","type":"LOCAL"},{"code":"414169","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934445 = Hospital System Supply Identifier | 414169 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X14","code_information":[{"code":"Sx00-1050-461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934448","type":"LOCAL"},{"code":"414171","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934448 = Hospital System Supply Identifier | 414171 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X22","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934452","type":"LOCAL"},{"code":"414175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934452 = Hospital System Supply Identifier | 414175 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X26MM","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934456","type":"LOCAL"},{"code":"399860","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934456 = Hospital System Supply Identifier | 399860 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X28MM","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934457","type":"LOCAL"},{"code":"399861","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934457 = Hospital System Supply Identifier | 399861 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X20","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934451","type":"LOCAL"},{"code":"414174","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934451 = Hospital System Supply Identifier | 414174 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X24","code_information":[{"code":"Sx00-1050-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934453","type":"LOCAL"},{"code":"414176","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934453 = Hospital System Supply Identifier | 414176 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X36","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934461","type":"LOCAL"},{"code":"414177","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934461 = Hospital System Supply Identifier | 414177 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X38MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934462","type":"LOCAL"},{"code":"399865","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934462 = Hospital System Supply Identifier | 399865 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X30MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934458","type":"LOCAL"},{"code":"399862","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934458 = Hospital System Supply Identifier | 399862 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X32MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934459","type":"LOCAL"},{"code":"399863","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934459 = Hospital System Supply Identifier | 399863 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X34MM","code_information":[{"code":"Sx00-1050-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934460","type":"LOCAL"},{"code":"399864","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934460 = Hospital System Supply Identifier | 399864 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X42MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934464","type":"LOCAL"},{"code":"399866","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934464 = Hospital System Supply Identifier | 399866 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X44MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934465","type":"LOCAL"},{"code":"399867","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934465 = Hospital System Supply Identifier | 399867 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X46MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934466","type":"LOCAL"},{"code":"399868","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934466 = Hospital System Supply Identifier | 399868 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X48MM","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934467","type":"LOCAL"},{"code":"399869","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934467 = Hospital System Supply Identifier | 399869 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X40","code_information":[{"code":"Sx00-1050-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934463","type":"LOCAL"},{"code":"414178","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934463 = Hospital System Supply Identifier | 414178 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X54","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934470","type":"LOCAL"},{"code":"414180","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934470 = Hospital System Supply Identifier | 414180 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X58MM","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934472","type":"LOCAL"},{"code":"399872","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934472 = Hospital System Supply Identifier | 399872 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X50","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934468","type":"LOCAL"},{"code":"414179","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934468 = Hospital System Supply Identifier | 414179 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X52MM","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934469","type":"LOCAL"},{"code":"399870","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934469 = Hospital System Supply Identifier | 399870 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X56MM","code_information":[{"code":"Sx00-1050-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934471","type":"LOCAL"},{"code":"399871","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934471 = Hospital System Supply Identifier | 399871 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X60MM","code_information":[{"code":"Sx00-1050-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934473","type":"LOCAL"},{"code":"399873","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934473 = Hospital System Supply Identifier | 399873 = Lawson ID"}]},{"description":"SCREW PED CORT LOK FT 4.5X65MM","code_information":[{"code":"Sx00-1050-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934474","type":"LOCAL"},{"code":"399874","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934474 = Hospital System Supply Identifier | 399874 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X70","code_information":[{"code":"Sx00-1050-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934475","type":"LOCAL"},{"code":"414181","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934475 = Hospital System Supply Identifier | 414181 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X75","code_information":[{"code":"Sx00-1050-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934476","type":"LOCAL"},{"code":"414182","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934476 = Hospital System Supply Identifier | 414182 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X85","code_information":[{"code":"Sx00-1050-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934478","type":"LOCAL"},{"code":"414184","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934478 = Hospital System Supply Identifier | 414184 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X80","code_information":[{"code":"Sx00-1050-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934477","type":"LOCAL"},{"code":"414183","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934477 = Hospital System Supply Identifier | 414183 = Lawson ID"}]},{"description":"SCREW PED CORT LOK F/T 4.5X90","code_information":[{"code":"Sx00-1050-469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934479","type":"LOCAL"},{"code":"414185","type":"LOCAL"}],"standard_charges":[{"gross_charge":1369.98,"discounted_cash":958.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934479 = Hospital System Supply Identifier | 414185 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878169","type":"LOCAL"},{"code":"876836","type":"LOCAL"}],"standard_charges":[{"gross_charge":10132.0,"discounted_cash":7092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878169 = Hospital System Supply Identifier | 876836 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878168","type":"LOCAL"},{"code":"876835","type":"LOCAL"}],"standard_charges":[{"gross_charge":10132.0,"discounted_cash":7092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878168 = Hospital System Supply Identifier | 876835 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 4OFF 4H","code_information":[{"code":"Sx00-1050-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878170","type":"LOCAL"},{"code":"876837","type":"LOCAL"}],"standard_charges":[{"gross_charge":10132.0,"discounted_cash":7092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878170 = Hospital System Supply Identifier | 876837 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 4OFF 6H","code_information":[{"code":"Sx00-1050-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878171","type":"LOCAL"},{"code":"876838","type":"LOCAL"}],"standard_charges":[{"gross_charge":10132.0,"discounted_cash":7092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878171 = Hospital System Supply Identifier | 876838 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 8OFF 4H","code_information":[{"code":"Sx00-1050-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878172","type":"LOCAL"},{"code":"876839","type":"LOCAL"}],"standard_charges":[{"gross_charge":10132.0,"discounted_cash":7092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878172 = Hospital System Supply Identifier | 876839 = Lawson ID"}]},{"description":"PLATE DFOS 90D 3.5 18D 8OFF 6H","code_information":[{"code":"Sx00-1050-520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878173","type":"LOCAL"},{"code":"876840","type":"LOCAL"}],"standard_charges":[{"gross_charge":10132.0,"discounted_cash":7092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878173 = Hospital System Supply Identifier | 876840 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878174","type":"LOCAL"},{"code":"876841","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878174 = Hospital System Supply Identifier | 876841 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878175","type":"LOCAL"},{"code":"876842","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878175 = Hospital System Supply Identifier | 876842 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 18D 4OFF 4H","code_information":[{"code":"Sx00-1050-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878176","type":"LOCAL"},{"code":"876843","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878176 = Hospital System Supply Identifier | 876843 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 18D 4OFF 6H","code_information":[{"code":"Sx00-1050-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878177","type":"LOCAL"},{"code":"876844","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878177 = Hospital System Supply Identifier | 876844 = Lawson ID"}]},{"description":"PLATE DFOS 90D 4.5 18D 8OFF 6H","code_information":[{"code":"Sx00-1050-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878178","type":"LOCAL"},{"code":"876845","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878178 = Hospital System Supply Identifier | 876845 = Lawson ID"}]},{"description":"PLATE BONE 4.5MM 90D DFOS 18D","code_information":[{"code":"Sx00-1050-620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934480","type":"LOCAL"},{"code":"841865","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934480 = Hospital System Supply Identifier | 841865 = Lawson ID"}]},{"description":"PLATE DFOS 80D 3.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878179","type":"LOCAL"},{"code":"876846","type":"LOCAL"}],"standard_charges":[{"gross_charge":10132.0,"discounted_cash":7092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878179 = Hospital System Supply Identifier | 876846 = Lawson ID"}]},{"description":"PLATE DFOS 80D 3.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878180","type":"LOCAL"},{"code":"876847","type":"LOCAL"}],"standard_charges":[{"gross_charge":10132.0,"discounted_cash":7092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878180 = Hospital System Supply Identifier | 876847 = Lawson ID"}]},{"description":"PLATE DFOS 80D 4.5 5D N/OFF 4H","code_information":[{"code":"Sx00-1050-800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878181","type":"LOCAL"},{"code":"876848","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878181 = Hospital System Supply Identifier | 876848 = Lawson ID"}]},{"description":"PLATE DFOS 80D 4.5 5D N/OFF 6H","code_information":[{"code":"Sx00-1050-800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878182","type":"LOCAL"},{"code":"876849","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878182 = Hospital System Supply Identifier | 876849 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ4","code_information":[{"code":"Sx00-1065-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878183","type":"LOCAL"},{"code":"876850","type":"LOCAL"}],"standard_charges":[{"gross_charge":8620.03,"discounted_cash":6034.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878183 = Hospital System Supply Identifier | 876850 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ6","code_information":[{"code":"Sx00-1065-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878184","type":"LOCAL"},{"code":"876851","type":"LOCAL"}],"standard_charges":[{"gross_charge":8828.63,"discounted_cash":6180.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878184 = Hospital System Supply Identifier | 876851 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ8","code_information":[{"code":"Sx00-1065-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878185","type":"LOCAL"},{"code":"876852","type":"LOCAL"}],"standard_charges":[{"gross_charge":8944.47,"discounted_cash":6261.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878185 = Hospital System Supply Identifier | 876852 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ14","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878188","type":"LOCAL"},{"code":"876855","type":"LOCAL"}],"standard_charges":[{"gross_charge":9564.01,"discounted_cash":6694.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878188 = Hospital System Supply Identifier | 876855 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ16","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878189","type":"LOCAL"},{"code":"876856","type":"LOCAL"}],"standard_charges":[{"gross_charge":10738.72,"discounted_cash":7517.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878189 = Hospital System Supply Identifier | 876856 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ12","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878187","type":"LOCAL"},{"code":"876854","type":"LOCAL"}],"standard_charges":[{"gross_charge":9357.49,"discounted_cash":6550.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878187 = Hospital System Supply Identifier | 876854 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 R SZ10","code_information":[{"code":"Sx00-1065-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878186","type":"LOCAL"},{"code":"876853","type":"LOCAL"}],"standard_charges":[{"gross_charge":9150.98,"discounted_cash":6405.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878186 = Hospital System Supply Identifier | 876853 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ4","code_information":[{"code":"Sx00-1065-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878190","type":"LOCAL"},{"code":"876857","type":"LOCAL"}],"standard_charges":[{"gross_charge":8620.03,"discounted_cash":6034.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878190 = Hospital System Supply Identifier | 876857 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ6","code_information":[{"code":"Sx00-1065-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878191","type":"LOCAL"},{"code":"876858","type":"LOCAL"}],"standard_charges":[{"gross_charge":8828.63,"discounted_cash":6180.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878191 = Hospital System Supply Identifier | 876858 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ8","code_information":[{"code":"Sx00-1065-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878192","type":"LOCAL"},{"code":"876859","type":"LOCAL"}],"standard_charges":[{"gross_charge":8944.47,"discounted_cash":6261.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878192 = Hospital System Supply Identifier | 876859 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ10","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878193","type":"LOCAL"},{"code":"876860","type":"LOCAL"}],"standard_charges":[{"gross_charge":9150.98,"discounted_cash":6405.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878193 = Hospital System Supply Identifier | 876860 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ12","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878194","type":"LOCAL"},{"code":"876861","type":"LOCAL"}],"standard_charges":[{"gross_charge":9357.49,"discounted_cash":6550.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878194 = Hospital System Supply Identifier | 876861 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ14","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878195","type":"LOCAL"},{"code":"876862","type":"LOCAL"}],"standard_charges":[{"gross_charge":9564.01,"discounted_cash":6694.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878195 = Hospital System Supply Identifier | 876862 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 3.5 L SZ16","code_information":[{"code":"Sx00-1065-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878196","type":"LOCAL"},{"code":"876863","type":"LOCAL"}],"standard_charges":[{"gross_charge":10738.72,"discounted_cash":7517.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878196 = Hospital System Supply Identifier | 876863 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 18HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878201","type":"LOCAL"},{"code":"876868","type":"LOCAL"}],"standard_charges":[{"gross_charge":8484.58,"discounted_cash":5939.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878201 = Hospital System Supply Identifier | 876868 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 16HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878200","type":"LOCAL"},{"code":"876867","type":"LOCAL"}],"standard_charges":[{"gross_charge":8219.1,"discounted_cash":5753.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878200 = Hospital System Supply Identifier | 876867 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 10HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878197","type":"LOCAL"},{"code":"876864","type":"LOCAL"}],"standard_charges":[{"gross_charge":6301.0,"discounted_cash":4410.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878197 = Hospital System Supply Identifier | 876864 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 12HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878198","type":"LOCAL"},{"code":"876865","type":"LOCAL"}],"standard_charges":[{"gross_charge":6549.98,"discounted_cash":4584.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878198 = Hospital System Supply Identifier | 876865 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 3.5 14HL","code_information":[{"code":"Sx00-1065-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878199","type":"LOCAL"},{"code":"876866","type":"LOCAL"}],"standard_charges":[{"gross_charge":7007.0,"discounted_cash":4904.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878199 = Hospital System Supply Identifier | 876866 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ4","code_information":[{"code":"Sx00-1065-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878202","type":"LOCAL"},{"code":"876869","type":"LOCAL"}],"standard_charges":[{"gross_charge":10022.63,"discounted_cash":7015.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878202 = Hospital System Supply Identifier | 876869 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ6","code_information":[{"code":"Sx00-1065-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878203","type":"LOCAL"},{"code":"876870","type":"LOCAL"}],"standard_charges":[{"gross_charge":10277.42,"discounted_cash":7194.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878203 = Hospital System Supply Identifier | 876870 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ8","code_information":[{"code":"Sx00-1065-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878204","type":"LOCAL"},{"code":"876871","type":"LOCAL"}],"standard_charges":[{"gross_charge":10110.67,"discounted_cash":7077.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878204 = Hospital System Supply Identifier | 876871 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ18","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878209","type":"LOCAL"},{"code":"876876","type":"LOCAL"}],"standard_charges":[{"gross_charge":11851.11,"discounted_cash":8295.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878209 = Hospital System Supply Identifier | 876876 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ16","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878208","type":"LOCAL"},{"code":"876875","type":"LOCAL"}],"standard_charges":[{"gross_charge":10964.16,"discounted_cash":7674.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878208 = Hospital System Supply Identifier | 876875 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ14","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878207","type":"LOCAL"},{"code":"876874","type":"LOCAL"}],"standard_charges":[{"gross_charge":11379.65,"discounted_cash":7965.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878207 = Hospital System Supply Identifier | 876874 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ12","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878206","type":"LOCAL"},{"code":"876873","type":"LOCAL"}],"standard_charges":[{"gross_charge":11127.4,"discounted_cash":7789.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878206 = Hospital System Supply Identifier | 876873 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 R SZ10","code_information":[{"code":"Sx00-1065-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878205","type":"LOCAL"},{"code":"876872","type":"LOCAL"}],"standard_charges":[{"gross_charge":10872.57,"discounted_cash":7610.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878205 = Hospital System Supply Identifier | 876872 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ4","code_information":[{"code":"Sx00-1065-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878210","type":"LOCAL"},{"code":"876877","type":"LOCAL"}],"standard_charges":[{"gross_charge":10022.63,"discounted_cash":7015.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878210 = Hospital System Supply Identifier | 876877 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ6","code_information":[{"code":"Sx00-1065-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878211","type":"LOCAL"},{"code":"876878","type":"LOCAL"}],"standard_charges":[{"gross_charge":10277.42,"discounted_cash":7194.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878211 = Hospital System Supply Identifier | 876878 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ8","code_information":[{"code":"Sx00-1065-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878212","type":"LOCAL"},{"code":"876879","type":"LOCAL"}],"standard_charges":[{"gross_charge":10110.67,"discounted_cash":7077.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878212 = Hospital System Supply Identifier | 876879 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ18","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878217","type":"LOCAL"},{"code":"876884","type":"LOCAL"}],"standard_charges":[{"gross_charge":11851.11,"discounted_cash":8295.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878217 = Hospital System Supply Identifier | 876884 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ14","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878215","type":"LOCAL"},{"code":"876882","type":"LOCAL"}],"standard_charges":[{"gross_charge":11379.65,"discounted_cash":7965.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878215 = Hospital System Supply Identifier | 876882 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ16","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878216","type":"LOCAL"},{"code":"876883","type":"LOCAL"}],"standard_charges":[{"gross_charge":10964.16,"discounted_cash":7674.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878216 = Hospital System Supply Identifier | 876883 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ10","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878213","type":"LOCAL"},{"code":"876880","type":"LOCAL"}],"standard_charges":[{"gross_charge":10872.57,"discounted_cash":7610.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878213 = Hospital System Supply Identifier | 876880 = Lawson ID"}]},{"description":"PLATE FEM CNTR LOK 4.5 L SZ12","code_information":[{"code":"Sx00-1065-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878214","type":"LOCAL"},{"code":"876881","type":"LOCAL"}],"standard_charges":[{"gross_charge":11127.4,"discounted_cash":7789.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878214 = Hospital System Supply Identifier | 876881 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 10HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878218","type":"LOCAL"},{"code":"876885","type":"LOCAL"}],"standard_charges":[{"gross_charge":6549.98,"discounted_cash":4584.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878218 = Hospital System Supply Identifier | 876885 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 12HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878219","type":"LOCAL"},{"code":"876886","type":"LOCAL"}],"standard_charges":[{"gross_charge":6796.22,"discounted_cash":4757.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878219 = Hospital System Supply Identifier | 876886 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 14HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878220","type":"LOCAL"},{"code":"876887","type":"LOCAL"}],"standard_charges":[{"gross_charge":7134.75,"discounted_cash":4994.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878220 = Hospital System Supply Identifier | 876887 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 16HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878221","type":"LOCAL"},{"code":"876888","type":"LOCAL"}],"standard_charges":[{"gross_charge":8365.39,"discounted_cash":5855.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878221 = Hospital System Supply Identifier | 876888 = Lawson ID"}]},{"description":"PLATE FEM BOW LOK 4.5 18HL","code_information":[{"code":"Sx00-1065-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878222","type":"LOCAL"},{"code":"876889","type":"LOCAL"}],"standard_charges":[{"gross_charge":8733.81,"discounted_cash":6113.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878222 = Hospital System Supply Identifier | 876889 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 6HL","code_information":[{"code":"Sx00-1065-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878224","type":"LOCAL"},{"code":"876891","type":"LOCAL"}],"standard_charges":[{"gross_charge":5367.33,"discounted_cash":3757.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878224 = Hospital System Supply Identifier | 876891 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 4HL","code_information":[{"code":"Sx00-1065-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878223","type":"LOCAL"},{"code":"876890","type":"LOCAL"}],"standard_charges":[{"gross_charge":4724.91,"discounted_cash":3307.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878223 = Hospital System Supply Identifier | 876890 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 8HL","code_information":[{"code":"Sx00-1065-430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878225","type":"LOCAL"},{"code":"876892","type":"LOCAL"}],"standard_charges":[{"gross_charge":5954.14,"discounted_cash":4167.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878225 = Hospital System Supply Identifier | 876892 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 10HL","code_information":[{"code":"Sx00-1065-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878226","type":"LOCAL"},{"code":"876893","type":"LOCAL"}],"standard_charges":[{"gross_charge":6549.98,"discounted_cash":4584.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878226 = Hospital System Supply Identifier | 876893 = Lawson ID"}]},{"description":"PLATE FEM STR LOK 4.5 14HL","code_information":[{"code":"Sx00-1065-431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878227","type":"LOCAL"},{"code":"876894","type":"LOCAL"}],"standard_charges":[{"gross_charge":7134.75,"discounted_cash":4994.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878227 = Hospital System Supply Identifier | 876894 = Lawson ID"}]},{"description":"WASHERS","code_information":[{"code":"Sx00-1071-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878228","type":"LOCAL"},{"code":"876895","type":"LOCAL"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878228 = Hospital System Supply Identifier | 876895 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X30MM","code_information":[{"code":"Sx00-1071-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878229","type":"LOCAL"},{"code":"876896","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878229 = Hospital System Supply Identifier | 876896 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X35MM","code_information":[{"code":"Sx00-1071-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878230","type":"LOCAL"},{"code":"876897","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878230 = Hospital System Supply Identifier | 876897 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X40MM","code_information":[{"code":"Sx00-1071-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878231","type":"LOCAL"},{"code":"876898","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878231 = Hospital System Supply Identifier | 876898 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X45MM","code_information":[{"code":"Sx00-1071-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878232","type":"LOCAL"},{"code":"876899","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878232 = Hospital System Supply Identifier | 876899 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X50MM","code_information":[{"code":"Sx00-1071-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878233","type":"LOCAL"},{"code":"876900","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878233 = Hospital System Supply Identifier | 876900 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X55MM","code_information":[{"code":"Sx00-1071-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878234","type":"LOCAL"},{"code":"876901","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878234 = Hospital System Supply Identifier | 876901 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X60MM","code_information":[{"code":"Sx00-1071-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878235","type":"LOCAL"},{"code":"876902","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878235 = Hospital System Supply Identifier | 876902 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X65MM","code_information":[{"code":"Sx00-1071-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878236","type":"LOCAL"},{"code":"876903","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878236 = Hospital System Supply Identifier | 876903 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X75MM","code_information":[{"code":"Sx00-1071-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878238","type":"LOCAL"},{"code":"876905","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878238 = Hospital System Supply Identifier | 876905 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X70MM","code_information":[{"code":"Sx00-1071-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878237","type":"LOCAL"},{"code":"876904","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878237 = Hospital System Supply Identifier | 876904 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X80MM","code_information":[{"code":"Sx00-1071-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878239","type":"LOCAL"},{"code":"876906","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878239 = Hospital System Supply Identifier | 876906 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X85MM","code_information":[{"code":"Sx00-1071-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878240","type":"LOCAL"},{"code":"876907","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878240 = Hospital System Supply Identifier | 876907 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X90MM","code_information":[{"code":"Sx00-1071-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878241","type":"LOCAL"},{"code":"876908","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878241 = Hospital System Supply Identifier | 876908 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X95MM","code_information":[{"code":"Sx00-1071-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878244","type":"LOCAL"},{"code":"876909","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878244 = Hospital System Supply Identifier | 876909 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X100MM","code_information":[{"code":"Sx00-1071-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878245","type":"LOCAL"},{"code":"876910","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878245 = Hospital System Supply Identifier | 876910 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X105MM","code_information":[{"code":"Sx00-1071-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878246","type":"LOCAL"},{"code":"876911","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878246 = Hospital System Supply Identifier | 876911 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X110MM","code_information":[{"code":"Sx00-1071-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878247","type":"LOCAL"},{"code":"876912","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878247 = Hospital System Supply Identifier | 876912 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X115MM","code_information":[{"code":"Sx00-1071-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878248","type":"LOCAL"},{"code":"876913","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878248 = Hospital System Supply Identifier | 876913 = Lawson ID"}]},{"description":"SCREW CANN F/T 7X120MM","code_information":[{"code":"Sx00-1071-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878249","type":"LOCAL"},{"code":"876914","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878249 = Hospital System Supply Identifier | 876914 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X55MM","code_information":[{"code":"Sx00-1071-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878251","type":"LOCAL"},{"code":"876916","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878251 = Hospital System Supply Identifier | 876916 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X50MM","code_information":[{"code":"Sx00-1071-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878250","type":"LOCAL"},{"code":"876915","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878250 = Hospital System Supply Identifier | 876915 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X60MM","code_information":[{"code":"Sx00-1071-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878252","type":"LOCAL"},{"code":"876917","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878252 = Hospital System Supply Identifier | 876917 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X65MM","code_information":[{"code":"Sx00-1071-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878253","type":"LOCAL"},{"code":"876918","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878253 = Hospital System Supply Identifier | 876918 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X70MM","code_information":[{"code":"Sx00-1071-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878254","type":"LOCAL"},{"code":"876919","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878254 = Hospital System Supply Identifier | 876919 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X75MM","code_information":[{"code":"Sx00-1071-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878255","type":"LOCAL"},{"code":"876920","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878255 = Hospital System Supply Identifier | 876920 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X80MM","code_information":[{"code":"Sx00-1071-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878256","type":"LOCAL"},{"code":"876921","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878256 = Hospital System Supply Identifier | 876921 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X85MM","code_information":[{"code":"Sx00-1071-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878257","type":"LOCAL"},{"code":"876922","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878257 = Hospital System Supply Identifier | 876922 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X90MM","code_information":[{"code":"Sx00-1071-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878258","type":"LOCAL"},{"code":"876923","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878258 = Hospital System Supply Identifier | 876923 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X95MM","code_information":[{"code":"Sx00-1071-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878259","type":"LOCAL"},{"code":"876924","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878259 = Hospital System Supply Identifier | 876924 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X105MM","code_information":[{"code":"Sx00-1071-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878261","type":"LOCAL"},{"code":"876926","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878261 = Hospital System Supply Identifier | 876926 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X100MM","code_information":[{"code":"Sx00-1071-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878260","type":"LOCAL"},{"code":"876925","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878260 = Hospital System Supply Identifier | 876925 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X110MM","code_information":[{"code":"Sx00-1071-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878262","type":"LOCAL"},{"code":"876927","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878262 = Hospital System Supply Identifier | 876927 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X115MM","code_information":[{"code":"Sx00-1071-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878263","type":"LOCAL"},{"code":"876928","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878263 = Hospital System Supply Identifier | 876928 = Lawson ID"}]},{"description":"SCREW CANN 32MM THRD 7X120MM","code_information":[{"code":"Sx00-1071-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878264","type":"LOCAL"},{"code":"876929","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878264 = Hospital System Supply Identifier | 876929 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X30MM","code_information":[{"code":"Sx00-1071-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878265","type":"LOCAL"},{"code":"876930","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878265 = Hospital System Supply Identifier | 876930 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X35MM","code_information":[{"code":"Sx00-1071-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878266","type":"LOCAL"},{"code":"876931","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878266 = Hospital System Supply Identifier | 876931 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X40MM","code_information":[{"code":"Sx00-1071-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878267","type":"LOCAL"},{"code":"876932","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878267 = Hospital System Supply Identifier | 876932 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X45MM","code_information":[{"code":"Sx00-1071-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878268","type":"LOCAL"},{"code":"876933","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878268 = Hospital System Supply Identifier | 876933 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X55MM","code_information":[{"code":"Sx00-1071-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878270","type":"LOCAL"},{"code":"876935","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878270 = Hospital System Supply Identifier | 876935 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X50MM","code_information":[{"code":"Sx00-1071-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878269","type":"LOCAL"},{"code":"876934","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878269 = Hospital System Supply Identifier | 876934 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X60MM","code_information":[{"code":"Sx00-1071-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878271","type":"LOCAL"},{"code":"876936","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878271 = Hospital System Supply Identifier | 876936 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X65MM","code_information":[{"code":"Sx00-1071-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878272","type":"LOCAL"},{"code":"876937","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878272 = Hospital System Supply Identifier | 876937 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X70MM","code_information":[{"code":"Sx00-1071-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878273","type":"LOCAL"},{"code":"876938","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878273 = Hospital System Supply Identifier | 876938 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X75MM","code_information":[{"code":"Sx00-1071-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878274","type":"LOCAL"},{"code":"876939","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878274 = Hospital System Supply Identifier | 876939 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X80MM","code_information":[{"code":"Sx00-1071-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878275","type":"LOCAL"},{"code":"876940","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878275 = Hospital System Supply Identifier | 876940 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X85MM","code_information":[{"code":"Sx00-1071-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878276","type":"LOCAL"},{"code":"876941","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878276 = Hospital System Supply Identifier | 876941 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X90MM","code_information":[{"code":"Sx00-1071-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878277","type":"LOCAL"},{"code":"876942","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878277 = Hospital System Supply Identifier | 876942 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X95MM","code_information":[{"code":"Sx00-1071-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878278","type":"LOCAL"},{"code":"876943","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878278 = Hospital System Supply Identifier | 876943 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X100MM","code_information":[{"code":"Sx00-1071-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878279","type":"LOCAL"},{"code":"876944","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878279 = Hospital System Supply Identifier | 876944 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X105MM","code_information":[{"code":"Sx00-1071-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878280","type":"LOCAL"},{"code":"876945","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878280 = Hospital System Supply Identifier | 876945 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X110MM","code_information":[{"code":"Sx00-1071-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878281","type":"LOCAL"},{"code":"876946","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878281 = Hospital System Supply Identifier | 876946 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X115MM","code_information":[{"code":"Sx00-1071-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878282","type":"LOCAL"},{"code":"876947","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878282 = Hospital System Supply Identifier | 876947 = Lawson ID"}]},{"description":"SCREW CANN 16MM THRD 7X120MM","code_information":[{"code":"Sx00-1071-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878283","type":"LOCAL"},{"code":"876948","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878283 = Hospital System Supply Identifier | 876948 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X18MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878288","type":"LOCAL"},{"code":"876953","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878288 = Hospital System Supply Identifier | 876953 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X17MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878287","type":"LOCAL"},{"code":"876952","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878287 = Hospital System Supply Identifier | 876952 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X19MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878289","type":"LOCAL"},{"code":"876954","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878289 = Hospital System Supply Identifier | 876954 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X15MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878285","type":"LOCAL"},{"code":"876950","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878285 = Hospital System Supply Identifier | 876950 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X14MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878284","type":"LOCAL"},{"code":"876949","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878284 = Hospital System Supply Identifier | 876949 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X16MM","code_information":[{"code":"Sx00-1071-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878286","type":"LOCAL"},{"code":"876951","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878286 = Hospital System Supply Identifier | 876951 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X20MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878290","type":"LOCAL"},{"code":"876955","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878290 = Hospital System Supply Identifier | 876955 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X21MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878291","type":"LOCAL"},{"code":"876956","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878291 = Hospital System Supply Identifier | 876956 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X22MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878292","type":"LOCAL"},{"code":"876957","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878292 = Hospital System Supply Identifier | 876957 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X23MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878293","type":"LOCAL"},{"code":"876958","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878293 = Hospital System Supply Identifier | 876958 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X24MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878294","type":"LOCAL"},{"code":"876959","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878294 = Hospital System Supply Identifier | 876959 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X26MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878295","type":"LOCAL"},{"code":"876960","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878295 = Hospital System Supply Identifier | 876960 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X28MM","code_information":[{"code":"Sx00-1071-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878296","type":"LOCAL"},{"code":"876961","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878296 = Hospital System Supply Identifier | 876961 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X38MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878301","type":"LOCAL"},{"code":"876966","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878301 = Hospital System Supply Identifier | 876966 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X36MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878300","type":"LOCAL"},{"code":"876965","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878300 = Hospital System Supply Identifier | 876965 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X30MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878297","type":"LOCAL"},{"code":"876962","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878297 = Hospital System Supply Identifier | 876962 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X32MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878298","type":"LOCAL"},{"code":"876963","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878298 = Hospital System Supply Identifier | 876963 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X34MM","code_information":[{"code":"Sx00-1071-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878299","type":"LOCAL"},{"code":"876964","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878299 = Hospital System Supply Identifier | 876964 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X40MM","code_information":[{"code":"Sx00-1071-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878302","type":"LOCAL"},{"code":"876967","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878302 = Hospital System Supply Identifier | 876967 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X45MM","code_information":[{"code":"Sx00-1071-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878303","type":"LOCAL"},{"code":"876968","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878303 = Hospital System Supply Identifier | 876968 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X50MM","code_information":[{"code":"Sx00-1071-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878304","type":"LOCAL"},{"code":"876969","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878304 = Hospital System Supply Identifier | 876969 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X16MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878311","type":"LOCAL"},{"code":"876976","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878311 = Hospital System Supply Identifier | 876976 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X19MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878314","type":"LOCAL"},{"code":"876979","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878314 = Hospital System Supply Identifier | 876979 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X17MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878312","type":"LOCAL"},{"code":"876977","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878312 = Hospital System Supply Identifier | 876977 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X15MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878310","type":"LOCAL"},{"code":"876975","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878310 = Hospital System Supply Identifier | 876975 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X18MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878313","type":"LOCAL"},{"code":"876978","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878313 = Hospital System Supply Identifier | 876978 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X13MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878308","type":"LOCAL"},{"code":"876973","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878308 = Hospital System Supply Identifier | 876973 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X10MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878305","type":"LOCAL"},{"code":"876970","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878305 = Hospital System Supply Identifier | 876970 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X14MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878309","type":"LOCAL"},{"code":"876974","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878309 = Hospital System Supply Identifier | 876974 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X11MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878306","type":"LOCAL"},{"code":"876971","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878306 = Hospital System Supply Identifier | 876971 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X12MM","code_information":[{"code":"Sx00-1071-501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878307","type":"LOCAL"},{"code":"876972","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878307 = Hospital System Supply Identifier | 876972 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X20MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878315","type":"LOCAL"},{"code":"876980","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878315 = Hospital System Supply Identifier | 876980 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X21MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878316","type":"LOCAL"},{"code":"876981","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878316 = Hospital System Supply Identifier | 876981 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X22MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878317","type":"LOCAL"},{"code":"876982","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878317 = Hospital System Supply Identifier | 876982 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X23MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878318","type":"LOCAL"},{"code":"876983","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878318 = Hospital System Supply Identifier | 876983 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X24MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878319","type":"LOCAL"},{"code":"876984","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878319 = Hospital System Supply Identifier | 876984 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X26MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878320","type":"LOCAL"},{"code":"876985","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878320 = Hospital System Supply Identifier | 876985 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X28MM","code_information":[{"code":"Sx00-1071-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878321","type":"LOCAL"},{"code":"876986","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878321 = Hospital System Supply Identifier | 876986 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X38MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878326","type":"LOCAL"},{"code":"876991","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878326 = Hospital System Supply Identifier | 876991 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X36MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878325","type":"LOCAL"},{"code":"876990","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878325 = Hospital System Supply Identifier | 876990 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X30MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878322","type":"LOCAL"},{"code":"876987","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878322 = Hospital System Supply Identifier | 876987 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X32MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878323","type":"LOCAL"},{"code":"876988","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878323 = Hospital System Supply Identifier | 876988 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X34MM","code_information":[{"code":"Sx00-1071-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878324","type":"LOCAL"},{"code":"876989","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878324 = Hospital System Supply Identifier | 876989 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X40MM","code_information":[{"code":"Sx00-1071-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878327","type":"LOCAL"},{"code":"876992","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878327 = Hospital System Supply Identifier | 876992 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X45MM","code_information":[{"code":"Sx00-1071-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878328","type":"LOCAL"},{"code":"876993","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878328 = Hospital System Supply Identifier | 876993 = Lawson ID"}]},{"description":"SCREW CANN SHRT 3.0X50MM","code_information":[{"code":"Sx00-1071-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878329","type":"LOCAL"},{"code":"876994","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878329 = Hospital System Supply Identifier | 876994 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X16MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878333","type":"LOCAL"},{"code":"876998","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878333 = Hospital System Supply Identifier | 876998 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X18MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878334","type":"LOCAL"},{"code":"876999","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878334 = Hospital System Supply Identifier | 876999 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X14MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878332","type":"LOCAL"},{"code":"876997","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878332 = Hospital System Supply Identifier | 876997 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X12MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878331","type":"LOCAL"},{"code":"876996","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878331 = Hospital System Supply Identifier | 876996 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X10MM","code_information":[{"code":"Sx00-1071-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878330","type":"LOCAL"},{"code":"876995","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878330 = Hospital System Supply Identifier | 876995 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X20MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878335","type":"LOCAL"},{"code":"877000","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878335 = Hospital System Supply Identifier | 877000 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X22MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878336","type":"LOCAL"},{"code":"877001","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878336 = Hospital System Supply Identifier | 877001 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X24MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878337","type":"LOCAL"},{"code":"877002","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878337 = Hospital System Supply Identifier | 877002 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X26MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878338","type":"LOCAL"},{"code":"877003","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878338 = Hospital System Supply Identifier | 877003 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X28MM","code_information":[{"code":"Sx00-1071-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878339","type":"LOCAL"},{"code":"877004","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878339 = Hospital System Supply Identifier | 877004 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X38MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878345","type":"LOCAL"},{"code":"877010","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878345 = Hospital System Supply Identifier | 877010 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X36MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878344","type":"LOCAL"},{"code":"877009","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878344 = Hospital System Supply Identifier | 877009 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X35MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878343","type":"LOCAL"},{"code":"877008","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878343 = Hospital System Supply Identifier | 877008 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X32MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878341","type":"LOCAL"},{"code":"877006","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878341 = Hospital System Supply Identifier | 877006 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X30MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878340","type":"LOCAL"},{"code":"877005","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878340 = Hospital System Supply Identifier | 877005 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X34MM","code_information":[{"code":"Sx00-1071-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878342","type":"LOCAL"},{"code":"877007","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878342 = Hospital System Supply Identifier | 877007 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X48MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878351","type":"LOCAL"},{"code":"877016","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878351 = Hospital System Supply Identifier | 877016 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X40MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878346","type":"LOCAL"},{"code":"877011","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878346 = Hospital System Supply Identifier | 877011 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X42MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878347","type":"LOCAL"},{"code":"877012","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878347 = Hospital System Supply Identifier | 877012 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X44MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878348","type":"LOCAL"},{"code":"877013","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878348 = Hospital System Supply Identifier | 877013 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X45MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878349","type":"LOCAL"},{"code":"877014","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878349 = Hospital System Supply Identifier | 877014 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X46MM","code_information":[{"code":"Sx00-1071-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878350","type":"LOCAL"},{"code":"877015","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878350 = Hospital System Supply Identifier | 877015 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X55MM","code_information":[{"code":"Sx00-1071-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878353","type":"LOCAL"},{"code":"877018","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878353 = Hospital System Supply Identifier | 877018 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X50MM","code_information":[{"code":"Sx00-1071-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878352","type":"LOCAL"},{"code":"877017","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878352 = Hospital System Supply Identifier | 877017 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.5X60MM","code_information":[{"code":"Sx00-1071-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878354","type":"LOCAL"},{"code":"877019","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878354 = Hospital System Supply Identifier | 877019 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X30MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878355","type":"LOCAL"},{"code":"877020","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878355 = Hospital System Supply Identifier | 877020 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X32MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878356","type":"LOCAL"},{"code":"877021","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878356 = Hospital System Supply Identifier | 877021 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X34MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878357","type":"LOCAL"},{"code":"877022","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878357 = Hospital System Supply Identifier | 877022 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X36MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878358","type":"LOCAL"},{"code":"877023","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878358 = Hospital System Supply Identifier | 877023 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X38MM","code_information":[{"code":"Sx00-1071-703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878359","type":"LOCAL"},{"code":"877024","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878359 = Hospital System Supply Identifier | 877024 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X46MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878363","type":"LOCAL"},{"code":"877028","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878363 = Hospital System Supply Identifier | 877028 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X44MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878362","type":"LOCAL"},{"code":"877027","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878362 = Hospital System Supply Identifier | 877027 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X48MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878364","type":"LOCAL"},{"code":"877029","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878364 = Hospital System Supply Identifier | 877029 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X40MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878360","type":"LOCAL"},{"code":"877025","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878360 = Hospital System Supply Identifier | 877025 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X42MM","code_information":[{"code":"Sx00-1071-704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878361","type":"LOCAL"},{"code":"877026","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878361 = Hospital System Supply Identifier | 877026 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X50MM","code_information":[{"code":"Sx00-1071-705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878365","type":"LOCAL"},{"code":"877030","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878365 = Hospital System Supply Identifier | 877030 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X55MM","code_information":[{"code":"Sx00-1071-705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878366","type":"LOCAL"},{"code":"877031","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878366 = Hospital System Supply Identifier | 877031 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X60MM","code_information":[{"code":"Sx00-1071-706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878367","type":"LOCAL"},{"code":"877032","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878367 = Hospital System Supply Identifier | 877032 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X10MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878368","type":"LOCAL"},{"code":"877033","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878368 = Hospital System Supply Identifier | 877033 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X12MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878369","type":"LOCAL"},{"code":"877034","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878369 = Hospital System Supply Identifier | 877034 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X14MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878370","type":"LOCAL"},{"code":"877035","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878370 = Hospital System Supply Identifier | 877035 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X16MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878371","type":"LOCAL"},{"code":"877036","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878371 = Hospital System Supply Identifier | 877036 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X18MM","code_information":[{"code":"Sx00-1071-821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878372","type":"LOCAL"},{"code":"877037","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878372 = Hospital System Supply Identifier | 877037 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X28MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878377","type":"LOCAL"},{"code":"877042","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878377 = Hospital System Supply Identifier | 877042 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X26MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878376","type":"LOCAL"},{"code":"877041","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878376 = Hospital System Supply Identifier | 877041 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X22MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878374","type":"LOCAL"},{"code":"877039","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878374 = Hospital System Supply Identifier | 877039 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X20MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878373","type":"LOCAL"},{"code":"877038","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878373 = Hospital System Supply Identifier | 877038 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X24MM","code_information":[{"code":"Sx00-1071-822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878375","type":"LOCAL"},{"code":"877040","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878375 = Hospital System Supply Identifier | 877040 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X30MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878378","type":"LOCAL"},{"code":"877043","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878378 = Hospital System Supply Identifier | 877043 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X32MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878379","type":"LOCAL"},{"code":"877044","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878379 = Hospital System Supply Identifier | 877044 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X34MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878380","type":"LOCAL"},{"code":"877045","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878380 = Hospital System Supply Identifier | 877045 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X36MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878381","type":"LOCAL"},{"code":"877046","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878381 = Hospital System Supply Identifier | 877046 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X38MM","code_information":[{"code":"Sx00-1071-823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878382","type":"LOCAL"},{"code":"877047","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878382 = Hospital System Supply Identifier | 877047 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X44MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878385","type":"LOCAL"},{"code":"877050","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878385 = Hospital System Supply Identifier | 877050 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X48MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878387","type":"LOCAL"},{"code":"877052","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878387 = Hospital System Supply Identifier | 877052 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X46MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878386","type":"LOCAL"},{"code":"877051","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878386 = Hospital System Supply Identifier | 877051 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X42MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878384","type":"LOCAL"},{"code":"877049","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878384 = Hospital System Supply Identifier | 877049 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X40MM","code_information":[{"code":"Sx00-1071-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878383","type":"LOCAL"},{"code":"877048","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878383 = Hospital System Supply Identifier | 877048 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X50MM","code_information":[{"code":"Sx00-1071-825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878388","type":"LOCAL"},{"code":"877053","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878388 = Hospital System Supply Identifier | 877053 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X55MM","code_information":[{"code":"Sx00-1071-825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878389","type":"LOCAL"},{"code":"877054","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878389 = Hospital System Supply Identifier | 877054 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X60MM","code_information":[{"code":"Sx00-1071-826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878390","type":"LOCAL"},{"code":"877055","type":"LOCAL"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":632.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878390 = Hospital System Supply Identifier | 877055 = Lawson ID"}]},{"description":"CEM BONE DOUGH-TYPE 40/20","code_information":[{"code":"Sx00-1102-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36476","type":"LOCAL"},{"code":"100111","type":"LOCAL"}],"standard_charges":[{"gross_charge":339.5,"discounted_cash":237.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36476 = Hospital System Supply Identifier | 100111 = Lawson ID"}]},{"description":"CEM BONE PALACOS-R 40GM","code_information":[{"code":"Sx00-1112-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"3358","type":"LOCAL"},{"code":"141046","type":"LOCAL"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 3358 = Hospital System Supply Identifier | 141046 = Lawson ID"}]},{"description":"OFF CONTRACT USE 702836 - CEM BONE PALACOS-R/G 40GM","code_information":[{"code":"Sx00-1113-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"12496","type":"LOCAL"},{"code":"238388","type":"LOCAL"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12496 = Hospital System Supply Identifier | 238388 = Lawson ID"}]},{"description":"CEM BONE PALACOS-LV 40GM","code_information":[{"code":"Sx00-1118-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"26755","type":"LOCAL"},{"code":"308782","type":"LOCAL"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 26755 = Hospital System Supply Identifier | 308782 = Lawson ID"}]},{"description":"CEM BONE PALACOS-LV/G 40GM","code_information":[{"code":"Sx00-1119-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"26756","type":"LOCAL"},{"code":"308783","type":"LOCAL"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 26756 = Hospital System Supply Identifier | 308783 = Lawson ID"}]},{"description":"INST DRIVER SCRW MINI MAGNA","code_information":[{"code":"Sx00-1142-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"12266","type":"LOCAL"},{"code":"237164","type":"LOCAL"}],"standard_charges":[{"gross_charge":1173.9,"discounted_cash":821.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12266 = Hospital System Supply Identifier | 237164 = Lawson ID"}]},{"description":"DISC - DRILL CANNUL 3.5","code_information":[{"code":"Sx00-1142-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"383160","type":"LOCAL"},{"code":"148674","type":"LOCAL"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":595.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383160 = Hospital System Supply Identifier | 148674 = Lawson ID"}]},{"description":"DISC - SCREW DEPTH GAUGE FOR 4.0","code_information":[{"code":"Sx00-1142-014","type":"CDM"},{"code":"272","type":"RC"},{"code":"12111","type":"LOCAL"},{"code":"236519","type":"LOCAL"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12111 = Hospital System Supply Identifier | 236519 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X36MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11918","type":"LOCAL"},{"code":"235490","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11918 = Hospital System Supply Identifier | 235490 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X40MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11919","type":"LOCAL"},{"code":"235491","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11919 = Hospital System Supply Identifier | 235491 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X44MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11920","type":"LOCAL"},{"code":"235492","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11920 = Hospital System Supply Identifier | 235492 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X55MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11921","type":"LOCAL"},{"code":"235493","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11921 = Hospital System Supply Identifier | 235493 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X48MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"30843","type":"LOCAL"},{"code":"323779","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 30843 = Hospital System Supply Identifier | 323779 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X28MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1989","type":"LOCAL"},{"code":"339430","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1989 = Hospital System Supply Identifier | 339430 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X32MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1990","type":"LOCAL"},{"code":"339431","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1990 = Hospital System Supply Identifier | 339431 = Lawson ID"}]},{"description":"SCREW CANN F/T 4.0X65MM","code_information":[{"code":"Sx00-1142-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1991","type":"LOCAL"},{"code":"339432","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1991 = Hospital System Supply Identifier | 339432 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X60MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1999","type":"LOCAL"},{"code":"339437","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1999 = Hospital System Supply Identifier | 339437 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X48MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1995","type":"LOCAL"},{"code":"339436","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1995 = Hospital System Supply Identifier | 339436 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X30MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1993","type":"LOCAL"},{"code":"339434","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1993 = Hospital System Supply Identifier | 339434 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X55MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11932","type":"LOCAL"},{"code":"235504","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11932 = Hospital System Supply Identifier | 235504 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X50MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11931","type":"LOCAL"},{"code":"235503","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11931 = Hospital System Supply Identifier | 235503 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X46MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11930","type":"LOCAL"},{"code":"235502","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11930 = Hospital System Supply Identifier | 235502 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X36MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1994","type":"LOCAL"},{"code":"339435","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1994 = Hospital System Supply Identifier | 339435 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X42MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11928","type":"LOCAL"},{"code":"235500","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11928 = Hospital System Supply Identifier | 235500 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X40MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11927","type":"LOCAL"},{"code":"235499","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11927 = Hospital System Supply Identifier | 235499 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X38MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11926","type":"LOCAL"},{"code":"235498","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11926 = Hospital System Supply Identifier | 235498 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X34MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11925","type":"LOCAL"},{"code":"235497","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11925 = Hospital System Supply Identifier | 235497 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X32MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11924","type":"LOCAL"},{"code":"235496","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11924 = Hospital System Supply Identifier | 235496 = Lawson ID"}]},{"description":"SCREW CANN P/T 4X44MM","code_information":[{"code":"Sx00-1142-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11929","type":"LOCAL"},{"code":"235501","type":"LOCAL"}],"standard_charges":[{"gross_charge":799.45,"discounted_cash":559.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11929 = Hospital System Supply Identifier | 235501 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X44MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11942","type":"LOCAL"},{"code":"235526","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11942 = Hospital System Supply Identifier | 235526 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X48MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11943","type":"LOCAL"},{"code":"235527","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11943 = Hospital System Supply Identifier | 235527 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X55MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11944","type":"LOCAL"},{"code":"235528","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11944 = Hospital System Supply Identifier | 235528 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X12MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2001","type":"LOCAL"},{"code":"339439","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2001 = Hospital System Supply Identifier | 339439 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X16MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2002","type":"LOCAL"},{"code":"339440","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2002 = Hospital System Supply Identifier | 339440 = Lawson ID"}]},{"description":"SCREW CANN F/T 5.0X65MM","code_information":[{"code":"Sx00-1142-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2005","type":"LOCAL"},{"code":"339443","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2005 = Hospital System Supply Identifier | 339443 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X65","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36624","type":"LOCAL"},{"code":"116086","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36624 = Hospital System Supply Identifier | 116086 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X60","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36623","type":"LOCAL"},{"code":"116084","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36623 = Hospital System Supply Identifier | 116084 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X55","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36622","type":"LOCAL"},{"code":"116083","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36622 = Hospital System Supply Identifier | 116083 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X50","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36621","type":"LOCAL"},{"code":"116082","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36621 = Hospital System Supply Identifier | 116082 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X30","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36611","type":"LOCAL"},{"code":"116071","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36611 = Hospital System Supply Identifier | 116071 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X46","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36619","type":"LOCAL"},{"code":"116080","type":"LOCAL"}],"standard_charges":[{"gross_charge":874.8,"discounted_cash":612.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36619 = Hospital System Supply Identifier | 116080 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X34","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36613","type":"LOCAL"},{"code":"116073","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36613 = Hospital System Supply Identifier | 116073 = Lawson ID"}]},{"description":"SCREW CANN MINI MAGNA-FX 5X48","code_information":[{"code":"Sx00-1142-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"36620","type":"LOCAL"},{"code":"116081","type":"LOCAL"}],"standard_charges":[{"gross_charge":812.5,"discounted_cash":568.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36620 = Hospital System Supply Identifier | 116081 = Lawson ID"}]},{"description":"DISC - TAP SURG CANN CHS SCRW 7MM","code_information":[{"code":"Sx00-1146-007","type":"CDM"},{"code":"272","type":"RC"},{"code":"383171","type":"LOCAL"},{"code":"202373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383171 = Hospital System Supply Identifier | 202373 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X30","code_information":[{"code":"Sx00-1146-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"67780","type":"LOCAL"},{"code":"201497","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 67780 = Hospital System Supply Identifier | 201497 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X55","code_information":[{"code":"Sx00-1146-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68016","type":"LOCAL"},{"code":"205031","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68016 = Hospital System Supply Identifier | 205031 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X75","code_information":[{"code":"Sx00-1146-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"67738","type":"LOCAL"},{"code":"201197","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 67738 = Hospital System Supply Identifier | 201197 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X80","code_information":[{"code":"Sx00-1146-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2173","type":"LOCAL"},{"code":"339795","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2173 = Hospital System Supply Identifier | 339795 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X80","code_information":[{"code":"Sx00-1146-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52518","type":"LOCAL"},{"code":"116091","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52518 = Hospital System Supply Identifier | 116091 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X80","code_information":[{"code":"Sx00-1146-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"67766","type":"LOCAL"},{"code":"201359","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 67766 = Hospital System Supply Identifier | 201359 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 16MM 7X85","code_information":[{"code":"Sx00-1146-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52519","type":"LOCAL"},{"code":"116092","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52519 = Hospital System Supply Identifier | 116092 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X85","code_information":[{"code":"Sx00-1146-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53341","type":"LOCAL"},{"code":"201198","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53341 = Hospital System Supply Identifier | 201198 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X85","code_information":[{"code":"Sx00-1146-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2174","type":"LOCAL"},{"code":"339796","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2174 = Hospital System Supply Identifier | 339796 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X90","code_information":[{"code":"Sx00-1146-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"67752","type":"LOCAL"},{"code":"201293","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 67752 = Hospital System Supply Identifier | 201293 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X90","code_information":[{"code":"Sx00-1146-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2175","type":"LOCAL"},{"code":"339797","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2175 = Hospital System Supply Identifier | 339797 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX 32MM 7X95","code_information":[{"code":"Sx00-1146-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"67765","type":"LOCAL"},{"code":"201358","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 67765 = Hospital System Supply Identifier | 201358 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X100","code_information":[{"code":"Sx00-1146-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2177","type":"LOCAL"},{"code":"339799","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2177 = Hospital System Supply Identifier | 339799 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X105","code_information":[{"code":"Sx00-1146-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2178","type":"LOCAL"},{"code":"339800","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2178 = Hospital System Supply Identifier | 339800 = Lawson ID"}]},{"description":"SCREW CANN MAGNA-FX F/T 7X110","code_information":[{"code":"Sx00-1146-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2179","type":"LOCAL"},{"code":"339801","type":"LOCAL"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":618.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2179 = Hospital System Supply Identifier | 339801 = Lawson ID"}]},{"description":"DUP USE 815633 - PIN GUIDE 1.6MM","code_information":[{"code":"Sx00-1147-006","type":"CDM"},{"code":"272","type":"RC"},{"code":"5205","type":"LOCAL"},{"code":"343898","type":"LOCAL"}],"standard_charges":[{"gross_charge":1350.54,"discounted_cash":945.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5205 = Hospital System Supply Identifier | 343898 = Lawson ID"}]},{"description":"DUP USE 815634 - PIN GUIDE 3.2MM","code_information":[{"code":"Sx00-1147-009","type":"CDM"},{"code":"272","type":"RC"},{"code":"5226","type":"LOCAL"},{"code":"343919","type":"LOCAL"}],"standard_charges":[{"gross_charge":1350.54,"discounted_cash":945.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5226 = Hospital System Supply Identifier | 343919 = Lawson ID"}]},{"description":"DRILL CANN Q/C 2.3MM","code_information":[{"code":"Sx00-1147-024","type":"CDM"},{"code":"272","type":"RC"},{"code":"383571","type":"LOCAL"},{"code":"395445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1084.28,"discounted_cash":759.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383571 = Hospital System Supply Identifier | 395445 = Lawson ID"}]},{"description":"BIT DRILL CANN Q/C 2.7MM","code_information":[{"code":"Sx00-1147-026","type":"CDM"},{"code":"272","type":"RC"},{"code":"27463","type":"LOCAL"},{"code":"314877","type":"LOCAL"}],"standard_charges":[{"gross_charge":1109.7,"discounted_cash":776.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 27463 = Hospital System Supply Identifier | 314877 = Lawson ID"}]},{"description":"DRILL CANN Q/C 3.2MM","code_information":[{"code":"Sx00-1147-027","type":"CDM"},{"code":"272","type":"RC"},{"code":"383369","type":"LOCAL"},{"code":"393263","type":"LOCAL"}],"standard_charges":[{"gross_charge":1239.63,"discounted_cash":867.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383369 = Hospital System Supply Identifier | 393263 = Lawson ID"}]},{"description":"BIT DRILL CANN Q/C 4.5MM","code_information":[{"code":"Sx00-1147-028","type":"CDM"},{"code":"272","type":"RC"},{"code":"2185","type":"LOCAL"},{"code":"339806","type":"LOCAL"}],"standard_charges":[{"gross_charge":1239.63,"discounted_cash":867.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2185 = Hospital System Supply Identifier | 339806 = Lawson ID"}]},{"description":"DRILL CANN Q/C 4.5MM","code_information":[{"code":"Sx00-1147-029","type":"CDM"},{"code":"272","type":"RC"},{"code":"383336","type":"LOCAL"},{"code":"387535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1239.63,"discounted_cash":867.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383336 = Hospital System Supply Identifier | 387535 = Lawson ID"}]},{"description":"BIT DRILL CANN Q/C 5.0MM","code_information":[{"code":"Sx00-1147-030","type":"CDM"},{"code":"272","type":"RC"},{"code":"27312","type":"LOCAL"},{"code":"314162","type":"LOCAL"}],"standard_charges":[{"gross_charge":1239.63,"discounted_cash":867.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 27312 = Hospital System Supply Identifier | 314162 = Lawson ID"}]},{"description":"TAP SURG CANN Q/C 4.0MM","code_information":[{"code":"Sx00-1147-038","type":"CDM"},{"code":"272","type":"RC"},{"code":"5202","type":"LOCAL"},{"code":"343895","type":"LOCAL"}],"standard_charges":[{"gross_charge":1239.63,"discounted_cash":867.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5202 = Hospital System Supply Identifier | 343895 = Lawson ID"}]},{"description":"TAP SURG CANN Q/C 6.5MM","code_information":[{"code":"Sx00-1147-041","type":"CDM"},{"code":"272","type":"RC"},{"code":"384883","type":"LOCAL"},{"code":"461757","type":"LOCAL"}],"standard_charges":[{"gross_charge":1239.63,"discounted_cash":867.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384883 = Hospital System Supply Identifier | 461757 = Lawson ID"}]},{"description":"PIN GDE CLUS","code_information":[{"code":"Sx00-1147-061","type":"CDM"},{"code":"272","type":"RC"},{"code":"5231","type":"LOCAL"},{"code":"343924","type":"LOCAL"}],"standard_charges":[{"gross_charge":3389.02,"discounted_cash":2372.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5231 = Hospital System Supply Identifier | 343924 = Lawson ID"}]},{"description":"FCP SCREW HLDING","code_information":[{"code":"Sx00-1147-080","type":"CDM"},{"code":"272","type":"RC"},{"code":"5203","type":"LOCAL"},{"code":"343896","type":"LOCAL"}],"standard_charges":[{"gross_charge":1198.49,"discounted_cash":838.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5203 = Hospital System Supply Identifier | 343896 = Lawson ID"}]},{"description":"WASHER CANN SCR 5.5-7.5MM 1.2","code_information":[{"code":"Sx00-1147-099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"669332","type":"LOCAL"},{"code":"732743","type":"LOCAL"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 669332 = Hospital System Supply Identifier | 732743 = Lawson ID"}]},{"description":"SCREW CANN MINI HERB 2.5X16MM","code_information":[{"code":"Sx00-1150-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"23375","type":"LOCAL"},{"code":"250825","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.52,"discounted_cash":892.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23375 = Hospital System Supply Identifier | 250825 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 12MM","code_information":[{"code":"Sx00-1152-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52463","type":"LOCAL"},{"code":"114304","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.27,"discounted_cash":842.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52463 = Hospital System Supply Identifier | 114304 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 14MM","code_information":[{"code":"Sx00-1152-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52464","type":"LOCAL"},{"code":"114305","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.27,"discounted_cash":842.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52464 = Hospital System Supply Identifier | 114305 = Lawson ID"}]},{"description":"DRILL TIP HERBERT DISP","code_information":[{"code":"Sx00-1152-015","type":"CDM"},{"code":"272","type":"RC"},{"code":"53275","type":"LOCAL"},{"code":"145717","type":"LOCAL"}],"standard_charges":[{"gross_charge":802.75,"discounted_cash":561.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53275 = Hospital System Supply Identifier | 145717 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 16MM","code_information":[{"code":"Sx00-1152-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52465","type":"LOCAL"},{"code":"114306","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.27,"discounted_cash":842.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52465 = Hospital System Supply Identifier | 114306 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 18MM","code_information":[{"code":"Sx00-1152-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"28320","type":"LOCAL"},{"code":"124103","type":"LOCAL"}],"standard_charges":[{"gross_charge":1693.32,"discounted_cash":1185.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 28320 = Hospital System Supply Identifier | 124103 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 20MM","code_information":[{"code":"Sx00-1152-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52466","type":"LOCAL"},{"code":"114307","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.27,"discounted_cash":842.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52466 = Hospital System Supply Identifier | 114307 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 22MM","code_information":[{"code":"Sx00-1152-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4171","type":"LOCAL"},{"code":"154038","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.27,"discounted_cash":842.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4171 = Hospital System Supply Identifier | 154038 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 24MM","code_information":[{"code":"Sx00-1152-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52467","type":"LOCAL"},{"code":"114309","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.27,"discounted_cash":842.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52467 = Hospital System Supply Identifier | 114309 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 26MM","code_information":[{"code":"Sx00-1152-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52468","type":"LOCAL"},{"code":"114310","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.27,"discounted_cash":842.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52468 = Hospital System Supply Identifier | 114310 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 28MM","code_information":[{"code":"Sx00-1152-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52469","type":"LOCAL"},{"code":"114311","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.27,"discounted_cash":842.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52469 = Hospital System Supply Identifier | 114311 = Lawson ID"}]},{"description":"SCREW CANN HERB/WHIPPLE 30MM","code_information":[{"code":"Sx00-1152-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52470","type":"LOCAL"},{"code":"114312","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.27,"discounted_cash":842.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52470 = Hospital System Supply Identifier | 114312 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 20H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2328","type":"LOCAL"},{"code":"339882","type":"LOCAL"}],"standard_charges":[{"gross_charge":1489.0,"discounted_cash":1042.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2328 = Hospital System Supply Identifier | 339882 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 18H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2327","type":"LOCAL"},{"code":"339881","type":"LOCAL"}],"standard_charges":[{"gross_charge":1389.71,"discounted_cash":972.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2327 = Hospital System Supply Identifier | 339881 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 24H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2330","type":"LOCAL"},{"code":"339884","type":"LOCAL"}],"standard_charges":[{"gross_charge":1552.95,"discounted_cash":1087.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2330 = Hospital System Supply Identifier | 339884 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 22H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2329","type":"LOCAL"},{"code":"339883","type":"LOCAL"}],"standard_charges":[{"gross_charge":1385.32,"discounted_cash":969.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2329 = Hospital System Supply Identifier | 339883 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 16H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2326","type":"LOCAL"},{"code":"339880","type":"LOCAL"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":787.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2326 = Hospital System Supply Identifier | 339880 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 8H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2322","type":"LOCAL"},{"code":"339876","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.01,"discounted_cash":767.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2322 = Hospital System Supply Identifier | 339876 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 12H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2324","type":"LOCAL"},{"code":"339878","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.01,"discounted_cash":767.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2324 = Hospital System Supply Identifier | 339878 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 10H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2323","type":"LOCAL"},{"code":"339877","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.01,"discounted_cash":767.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2323 = Hospital System Supply Identifier | 339877 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 14H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2325","type":"LOCAL"},{"code":"339879","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.01,"discounted_cash":767.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2325 = Hospital System Supply Identifier | 339879 = Lawson ID"}]},{"description":"PLATE RECON STR 2.7 6H","code_information":[{"code":"Sx00-1179-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2321","type":"LOCAL"},{"code":"339875","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.01,"discounted_cash":767.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2321 = Hospital System Supply Identifier | 339875 = Lawson ID"}]},{"description":"PLATE TUBE 130 1181-130-03","code_information":[{"code":"Sx00-1181-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52732","type":"LOCAL"},{"code":"201370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1303.14,"discounted_cash":912.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52732 = Hospital System Supply Identifier | 201370 = Lawson ID"}]},{"description":"PLATE TUBE 130 1181-130-02","code_information":[{"code":"Sx00-1181-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52737","type":"LOCAL"},{"code":"201833","type":"LOCAL"}],"standard_charges":[{"gross_charge":1303.14,"discounted_cash":912.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52737 = Hospital System Supply Identifier | 201833 = Lawson ID"}]},{"description":"PLATE TUBE 135 1181-135-03","code_information":[{"code":"Sx00-1181-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52715","type":"LOCAL"},{"code":"200695","type":"LOCAL"}],"standard_charges":[{"gross_charge":1303.14,"discounted_cash":912.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52715 = Hospital System Supply Identifier | 200695 = Lawson ID"}]},{"description":"PLATE TUBE 135 1181-135-02","code_information":[{"code":"Sx00-1181-135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52774","type":"LOCAL"},{"code":"203357","type":"LOCAL"}],"standard_charges":[{"gross_charge":1303.14,"discounted_cash":912.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52774 = Hospital System Supply Identifier | 203357 = Lawson ID"}]},{"description":"PLATE TUBE 140 1181-140-03","code_information":[{"code":"Sx00-1181-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52719","type":"LOCAL"},{"code":"201155","type":"LOCAL"}],"standard_charges":[{"gross_charge":1303.14,"discounted_cash":912.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52719 = Hospital System Supply Identifier | 201155 = Lawson ID"}]},{"description":"PLATE TUBE 140 1181-140-02","code_information":[{"code":"Sx00-1181-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52777","type":"LOCAL"},{"code":"203361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1303.14,"discounted_cash":912.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52777 = Hospital System Supply Identifier | 203361 = Lawson ID"}]},{"description":"PLATE TUBE 145 1181-145-03","code_information":[{"code":"Sx00-1181-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52722","type":"LOCAL"},{"code":"201175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1303.14,"discounted_cash":912.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52722 = Hospital System Supply Identifier | 201175 = Lawson ID"}]},{"description":"PLATE TUBE 145 1181-145-02","code_information":[{"code":"Sx00-1181-145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52787","type":"LOCAL"},{"code":"204507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1303.14,"discounted_cash":912.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52787 = Hospital System Supply Identifier | 204507 = Lawson ID"}]},{"description":"PLATE SUPCNDYL TB 150 2H","code_information":[{"code":"Sx00-1181-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"37511","type":"LOCAL"},{"code":"201531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1303.14,"discounted_cash":912.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37511 = Hospital System Supply Identifier | 201531 = Lawson ID"}]},{"description":"PLATE TUBE 150 1181-150-03","code_information":[{"code":"Sx00-1181-150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52796","type":"LOCAL"},{"code":"204516","type":"LOCAL"}],"standard_charges":[{"gross_charge":1303.14,"discounted_cash":912.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52796 = Hospital System Supply Identifier | 204516 = Lawson ID"}]},{"description":"WIRE SUT ORTH BEAD 18GA","code_information":[{"code":"Sx00-1191-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"21378","type":"LOCAL"},{"code":"103817","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 21378 = Hospital System Supply Identifier | 103817 = Lawson ID"}]},{"description":"WIRE SUT ORTH BEAD 16GA","code_information":[{"code":"Sx00-1191-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"28567","type":"LOCAL"},{"code":"131618","type":"LOCAL"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":66.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 28567 = Hospital System Supply Identifier | 131618 = Lawson ID"}]},{"description":"PLATE DHS VRSAFX2 95D 16H","code_information":[{"code":"Sx00-1193-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384354","type":"LOCAL"},{"code":"410379","type":"LOCAL"}],"standard_charges":[{"gross_charge":1862.19,"discounted_cash":1303.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384354 = Hospital System Supply Identifier | 410379 = Lawson ID"}]},{"description":"DISC - PUNCH ORTH TRAB","code_information":[{"code":"Sx00-1197-010","type":"CDM"},{"code":"272","type":"RC"},{"code":"662909","type":"LOCAL"},{"code":"421234","type":"LOCAL"}],"standard_charges":[{"gross_charge":1010.5,"discounted_cash":707.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 662909 = Hospital System Supply Identifier | 421234 = Lawson ID"}]},{"description":"ROD ORTH TRABCLR OSTNECROSIS","code_information":[{"code":"Sx00-1197-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"1947","type":"LOCAL"},{"code":"339245","type":"LOCAL"}],"standard_charges":[{"gross_charge":11339.41,"discounted_cash":7937.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1947 = Hospital System Supply Identifier | 339245 = Lawson ID"}]},{"description":"IMP HIP OSTEONECROSIS 10X90MM","code_information":[{"code":"Sx00-1197-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"384799","type":"LOCAL"},{"code":"439191","type":"LOCAL"}],"standard_charges":[{"gross_charge":11339.41,"discounted_cash":7937.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384799 = Hospital System Supply Identifier | 439191 = Lawson ID"}]},{"description":"IMP OSTEONECROSIS 10 X 95MM","code_information":[{"code":"Sx00-1197-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384861","type":"LOCAL"},{"code":"454951","type":"LOCAL"}],"standard_charges":[{"gross_charge":11339.41,"discounted_cash":7937.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384861 = Hospital System Supply Identifier | 454951 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 25X5X3H","code_information":[{"code":"Sx00-1200-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878391","type":"LOCAL"},{"code":"877056","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878391 = Hospital System Supply Identifier | 877056 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 30X5X3H","code_information":[{"code":"Sx00-1200-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878392","type":"LOCAL"},{"code":"877057","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878392 = Hospital System Supply Identifier | 877057 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 35X5X3H","code_information":[{"code":"Sx00-1200-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878393","type":"LOCAL"},{"code":"877058","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878393 = Hospital System Supply Identifier | 877058 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90 25X12X3H","code_information":[{"code":"Sx00-1200-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878394","type":"LOCAL"},{"code":"877059","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878394 = Hospital System Supply Identifier | 877059 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90 30X12X3H","code_information":[{"code":"Sx00-1200-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878395","type":"LOCAL"},{"code":"877060","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878395 = Hospital System Supply Identifier | 877060 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90 35X12X3H","code_information":[{"code":"Sx00-1200-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878396","type":"LOCAL"},{"code":"877061","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878396 = Hospital System Supply Identifier | 877061 = Lawson ID"}]},{"description":"BLADE PLATE 5MM X25MM 2H 90-DE","code_information":[{"code":"Sx00-1200-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934511","type":"LOCAL"},{"code":"800253","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934511 = Hospital System Supply Identifier | 800253 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 30X5X2H","code_information":[{"code":"Sx00-1200-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878397","type":"LOCAL"},{"code":"877062","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878397 = Hospital System Supply Identifier | 877062 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 90D 35X5X2H","code_information":[{"code":"Sx00-1200-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878398","type":"LOCAL"},{"code":"877063","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878398 = Hospital System Supply Identifier | 877063 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 55X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878405","type":"LOCAL"},{"code":"877070","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878405 = Hospital System Supply Identifier | 877070 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 50X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878404","type":"LOCAL"},{"code":"877069","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878404 = Hospital System Supply Identifier | 877069 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 45X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878403","type":"LOCAL"},{"code":"877068","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878403 = Hospital System Supply Identifier | 877068 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 60X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878406","type":"LOCAL"},{"code":"877071","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878406 = Hospital System Supply Identifier | 877071 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 35X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878401","type":"LOCAL"},{"code":"877066","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878401 = Hospital System Supply Identifier | 877066 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 25X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878399","type":"LOCAL"},{"code":"877064","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878399 = Hospital System Supply Identifier | 877064 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 40X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878402","type":"LOCAL"},{"code":"877067","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878402 = Hospital System Supply Identifier | 877067 = Lawson ID"}]},{"description":"PLATE BLD CANN INF 130 30X5X3H","code_information":[{"code":"Sx00-1200-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878400","type":"LOCAL"},{"code":"877065","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878400 = Hospital System Supply Identifier | 877065 = Lawson ID"}]},{"description":"PLATE BONE CANNULATED CHILD OSTEOTOMY 90 DEGREE 0012003005 6X50MM","code_information":[{"code":"Sx00-1200-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176238","type":"LOCAL"},{"code":"1082556","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176238 = Hospital System Supply Identifier | 1082556 = Lawson ID"}]},{"description":"PLATE 90DEG 40X6MM","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"636095","type":"LOCAL"},{"code":"711670","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 636095 = Hospital System Supply Identifier | 711670 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 25X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878407","type":"LOCAL"},{"code":"877072","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878407 = Hospital System Supply Identifier | 877072 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 30X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878408","type":"LOCAL"},{"code":"877073","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878408 = Hospital System Supply Identifier | 877073 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 35X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878409","type":"LOCAL"},{"code":"877074","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878409 = Hospital System Supply Identifier | 877074 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 50X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878411","type":"LOCAL"},{"code":"877076","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878411 = Hospital System Supply Identifier | 877076 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 25X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878412","type":"LOCAL"},{"code":"877077","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878412 = Hospital System Supply Identifier | 877077 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 30X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878413","type":"LOCAL"},{"code":"877078","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878413 = Hospital System Supply Identifier | 877078 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 35X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878414","type":"LOCAL"},{"code":"877079","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878414 = Hospital System Supply Identifier | 877079 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 40X10X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878415","type":"LOCAL"},{"code":"877080","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878415 = Hospital System Supply Identifier | 877080 = Lawson ID"}]},{"description":"PLATE BLD CANN CHLD 90 45X6X3H","code_information":[{"code":"Sx00-1200-350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878410","type":"LOCAL"},{"code":"877075","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878410 = Hospital System Supply Identifier | 877075 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 45X10X3H","code_information":[{"code":"Sx00-1200-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878416","type":"LOCAL"},{"code":"877081","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878416 = Hospital System Supply Identifier | 877081 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 90 50X10X3H","code_information":[{"code":"Sx00-1200-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878417","type":"LOCAL"},{"code":"877082","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878417 = Hospital System Supply Identifier | 877082 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 50X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878422","type":"LOCAL"},{"code":"877087","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878422 = Hospital System Supply Identifier | 877087 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 45X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878421","type":"LOCAL"},{"code":"877086","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878421 = Hospital System Supply Identifier | 877086 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 40X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878420","type":"LOCAL"},{"code":"877085","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878420 = Hospital System Supply Identifier | 877085 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 30X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878418","type":"LOCAL"},{"code":"877083","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878418 = Hospital System Supply Identifier | 877083 = Lawson ID"}]},{"description":"PLATE BONE 25MM 100-DEG 3-HOLE","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"934512","type":"LOCAL"},{"code":"800336","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 934512 = Hospital System Supply Identifier | 800336 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 100 35X6X3H","code_information":[{"code":"Sx00-1200-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878419","type":"LOCAL"},{"code":"877084","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878419 = Hospital System Supply Identifier | 877084 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 40X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878423","type":"LOCAL"},{"code":"877088","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878423 = Hospital System Supply Identifier | 877088 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 45X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878424","type":"LOCAL"},{"code":"877089","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878424 = Hospital System Supply Identifier | 877089 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 50X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878425","type":"LOCAL"},{"code":"877090","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878425 = Hospital System Supply Identifier | 877090 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 55X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878426","type":"LOCAL"},{"code":"877091","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878426 = Hospital System Supply Identifier | 877091 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 60X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878427","type":"LOCAL"},{"code":"877092","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878427 = Hospital System Supply Identifier | 877092 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 65X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878428","type":"LOCAL"},{"code":"877093","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878428 = Hospital System Supply Identifier | 877093 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 70X6X4H","code_information":[{"code":"Sx00-1200-450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878429","type":"LOCAL"},{"code":"877094","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878429 = Hospital System Supply Identifier | 877094 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 65X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878435","type":"LOCAL"},{"code":"877100","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878435 = Hospital System Supply Identifier | 877100 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 60X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878434","type":"LOCAL"},{"code":"877099","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878434 = Hospital System Supply Identifier | 877099 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 55X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878433","type":"LOCAL"},{"code":"877098","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878433 = Hospital System Supply Identifier | 877098 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 40X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878430","type":"LOCAL"},{"code":"877095","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878430 = Hospital System Supply Identifier | 877095 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 45X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878431","type":"LOCAL"},{"code":"877096","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878431 = Hospital System Supply Identifier | 877096 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 50X14X4H","code_information":[{"code":"Sx00-1200-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878432","type":"LOCAL"},{"code":"877097","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878432 = Hospital System Supply Identifier | 877097 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL90 70X14X4H","code_information":[{"code":"Sx00-1200-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878436","type":"LOCAL"},{"code":"877101","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878436 = Hospital System Supply Identifier | 877101 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 25X6X4H","code_information":[{"code":"Sx00-1200-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878437","type":"LOCAL"},{"code":"877102","type":"LOCAL"}],"standard_charges":[{"gross_charge":5385.6,"discounted_cash":3769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878437 = Hospital System Supply Identifier | 877102 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 30X6X4H","code_information":[{"code":"Sx00-1200-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878438","type":"LOCAL"},{"code":"877103","type":"LOCAL"}],"standard_charges":[{"gross_charge":5385.6,"discounted_cash":3769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878438 = Hospital System Supply Identifier | 877103 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL 90 35X6X4H","code_information":[{"code":"Sx00-1200-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878439","type":"LOCAL"},{"code":"877104","type":"LOCAL"}],"standard_charges":[{"gross_charge":5385.6,"discounted_cash":3769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878439 = Hospital System Supply Identifier | 877104 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 60X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878444","type":"LOCAL"},{"code":"877109","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878444 = Hospital System Supply Identifier | 877109 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 50X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878442","type":"LOCAL"},{"code":"877107","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878442 = Hospital System Supply Identifier | 877107 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 55X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878443","type":"LOCAL"},{"code":"877108","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878443 = Hospital System Supply Identifier | 877108 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 45X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878441","type":"LOCAL"},{"code":"877106","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878441 = Hospital System Supply Identifier | 877106 = Lawson ID"}]},{"description":"PLATE BLD CANN CHD 130 40X0 4H","code_information":[{"code":"Sx00-1200-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878440","type":"LOCAL"},{"code":"877105","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.52,"discounted_cash":3461.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878440 = Hospital System Supply Identifier | 877105 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006003 6X55MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176305","type":"LOCAL"},{"code":"1082448","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176305 = Hospital System Supply Identifier | 1082448 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006004 6X60MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175854","type":"LOCAL"},{"code":"1082464","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175854 = Hospital System Supply Identifier | 1082464 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006002 6X50MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176373","type":"LOCAL"},{"code":"1082483","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176373 = Hospital System Supply Identifier | 1082483 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006006 6X70MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176476","type":"LOCAL"},{"code":"1082534","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176476 = Hospital System Supply Identifier | 1082534 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006005 6X65MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176010","type":"LOCAL"},{"code":"1082547","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176010 = Hospital System Supply Identifier | 1082547 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006001 6X45MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176237","type":"LOCAL"},{"code":"1082571","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176237 = Hospital System Supply Identifier | 1082571 = Lawson ID"}]},{"description":"PLATE BONE BLADE LOCKING ADOLESCENT 4 HOLE OSTEOTOMY 0012006000 6X40MM","code_information":[{"code":"Sx00-1200-600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176239","type":"LOCAL"},{"code":"1082574","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176239 = Hospital System Supply Identifier | 1082574 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 80X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878452","type":"LOCAL"},{"code":"877117","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878452 = Hospital System Supply Identifier | 877117 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 75X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878451","type":"LOCAL"},{"code":"877116","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878451 = Hospital System Supply Identifier | 877116 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 70X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878450","type":"LOCAL"},{"code":"877115","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878450 = Hospital System Supply Identifier | 877115 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 65X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878449","type":"LOCAL"},{"code":"877114","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878449 = Hospital System Supply Identifier | 877114 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 45X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878445","type":"LOCAL"},{"code":"877110","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878445 = Hospital System Supply Identifier | 877110 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 55X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878447","type":"LOCAL"},{"code":"877112","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878447 = Hospital System Supply Identifier | 877112 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 50X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878446","type":"LOCAL"},{"code":"877111","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878446 = Hospital System Supply Identifier | 877111 = Lawson ID"}]},{"description":"PLATE BLD CANN ADOL130 60X0X4H","code_information":[{"code":"Sx00-1200-700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878448","type":"LOCAL"},{"code":"877113","type":"LOCAL"}],"standard_charges":[{"gross_charge":5072.66,"discounted_cash":3550.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878448 = Hospital System Supply Identifier | 877113 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 60X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878457","type":"LOCAL"},{"code":"877122","type":"LOCAL"}],"standard_charges":[{"gross_charge":5385.6,"discounted_cash":3769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878457 = Hospital System Supply Identifier | 877122 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 65X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878458","type":"LOCAL"},{"code":"877123","type":"LOCAL"}],"standard_charges":[{"gross_charge":5385.6,"discounted_cash":3769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878458 = Hospital System Supply Identifier | 877123 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 55X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878456","type":"LOCAL"},{"code":"877121","type":"LOCAL"}],"standard_charges":[{"gross_charge":5385.6,"discounted_cash":3769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878456 = Hospital System Supply Identifier | 877121 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 45X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878454","type":"LOCAL"},{"code":"877119","type":"LOCAL"}],"standard_charges":[{"gross_charge":5385.6,"discounted_cash":3769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878454 = Hospital System Supply Identifier | 877119 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 40X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878453","type":"LOCAL"},{"code":"877118","type":"LOCAL"}],"standard_charges":[{"gross_charge":5385.6,"discounted_cash":3769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878453 = Hospital System Supply Identifier | 877118 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 50X10 4H","code_information":[{"code":"Sx00-1200-804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878455","type":"LOCAL"},{"code":"877120","type":"LOCAL"}],"standard_charges":[{"gross_charge":5385.6,"discounted_cash":3769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878455 = Hospital System Supply Identifier | 877120 = Lawson ID"}]},{"description":"PLATE BLD CANN ADO110 70X10 4H","code_information":[{"code":"Sx00-1200-805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878459","type":"LOCAL"},{"code":"877124","type":"LOCAL"}],"standard_charges":[{"gross_charge":5385.6,"discounted_cash":3769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878459 = Hospital System Supply Identifier | 877124 = Lawson ID"}]},{"description":"SPLINT THOMAS LEG LG 45X9IN","code_information":[{"code":"Sx00-1232-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"369493","type":"LOCAL"},{"code":"449215","type":"LOCAL"}],"standard_charges":[{"gross_charge":794.2,"discounted_cash":555.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 369493 = Hospital System Supply Identifier | 449215 = Lawson ID"}]},{"description":"SPLINT THOMAS RADLUC LG","code_information":[{"code":"Sx00-1232-008","type":"CDM"},{"code":"272","type":"RC"},{"code":"369494","type":"LOCAL"},{"code":"449216","type":"LOCAL"}],"standard_charges":[{"gross_charge":1484.7,"discounted_cash":1039.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 369494 = Hospital System Supply Identifier | 449216 = Lawson ID"}]},{"description":"SPLINT PEARSON ATTACH LG 29IN","code_information":[{"code":"Sx00-1232-014","type":"CDM"},{"code":"272","type":"RC"},{"code":"369491","type":"LOCAL"},{"code":"449213","type":"LOCAL"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 369491 = Hospital System Supply Identifier | 449213 = Lawson ID"}]},{"description":"BIT DRILL FIXATION LONG 6.4MM","code_information":[{"code":"Sx00-1291-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"26251","type":"LOCAL"},{"code":"303894","type":"LOCAL"}],"standard_charges":[{"gross_charge":251.25,"discounted_cash":175.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 26251 = Hospital System Supply Identifier | 303894 = Lawson ID"}]},{"description":"BIT DRILIL SHANK 6.4X203MM","code_information":[{"code":"Sx00-1291-004","type":"CDM"},{"code":"272","type":"RC"},{"code":"384774","type":"LOCAL"},{"code":"437851","type":"LOCAL"}],"standard_charges":[{"gross_charge":827.4,"discounted_cash":579.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384774 = Hospital System Supply Identifier | 437851 = Lawson ID"}]},{"description":"WIRE SPN LUQUE 16GA","code_information":[{"code":"Sx00-1292-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68702","type":"LOCAL"},{"code":"217910","type":"LOCAL"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68702 = Hospital System Supply Identifier | 217910 = Lawson ID"}]},{"description":"DISC - WIRE SPN LUQUE 18GA","code_information":[{"code":"Sx00-1292-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68703","type":"LOCAL"},{"code":"217911","type":"LOCAL"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":279.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68703 = Hospital System Supply Identifier | 217911 = Lawson ID"}]},{"description":"SCREW WASHER CANN 2.5/3.0","code_information":[{"code":"Sx00-1400-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878460","type":"LOCAL"},{"code":"877125","type":"LOCAL"}],"standard_charges":[{"gross_charge":218.5,"discounted_cash":152.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878460 = Hospital System Supply Identifier | 877125 = Lawson ID"}]},{"description":"SCREW WASHER CANN 3.5/4.0","code_information":[{"code":"Sx00-1400-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878461","type":"LOCAL"},{"code":"877126","type":"LOCAL"}],"standard_charges":[{"gross_charge":218.5,"discounted_cash":152.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878461 = Hospital System Supply Identifier | 877126 = Lawson ID"}]},{"description":"SCREW WASHER CANN 4.5","code_information":[{"code":"Sx00-1400-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878462","type":"LOCAL"},{"code":"877127","type":"LOCAL"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878462 = Hospital System Supply Identifier | 877127 = Lawson ID"}]},{"description":"SCREW WASHER CANN 5.5","code_information":[{"code":"Sx00-1400-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878463","type":"LOCAL"},{"code":"877128","type":"LOCAL"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":178.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878463 = Hospital System Supply Identifier | 877128 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X8MM","code_information":[{"code":"Sx00-1400-250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878464","type":"LOCAL"},{"code":"877129","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878464 = Hospital System Supply Identifier | 877129 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X18MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878469","type":"LOCAL"},{"code":"877134","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878469 = Hospital System Supply Identifier | 877134 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X16MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878468","type":"LOCAL"},{"code":"877133","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878468 = Hospital System Supply Identifier | 877133 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X14MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878467","type":"LOCAL"},{"code":"877132","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878467 = Hospital System Supply Identifier | 877132 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X12MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878466","type":"LOCAL"},{"code":"877131","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878466 = Hospital System Supply Identifier | 877131 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X10MM","code_information":[{"code":"Sx00-1400-251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878465","type":"LOCAL"},{"code":"877130","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878465 = Hospital System Supply Identifier | 877130 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X20MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878470","type":"LOCAL"},{"code":"877135","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878470 = Hospital System Supply Identifier | 877135 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X22MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878471","type":"LOCAL"},{"code":"877136","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878471 = Hospital System Supply Identifier | 877136 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X24MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878472","type":"LOCAL"},{"code":"877137","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878472 = Hospital System Supply Identifier | 877137 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X26MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878473","type":"LOCAL"},{"code":"877138","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878473 = Hospital System Supply Identifier | 877138 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X28MM","code_information":[{"code":"Sx00-1400-252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878474","type":"LOCAL"},{"code":"877139","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878474 = Hospital System Supply Identifier | 877139 = Lawson ID"}]},{"description":"SCREW CANN F/T 2.5X30MM","code_information":[{"code":"Sx00-1400-253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878475","type":"LOCAL"},{"code":"877140","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878475 = Hospital System Supply Identifier | 877140 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X18MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878480","type":"LOCAL"},{"code":"877145","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878480 = Hospital System Supply Identifier | 877145 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X16MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878479","type":"LOCAL"},{"code":"877144","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878479 = Hospital System Supply Identifier | 877144 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X10MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878476","type":"LOCAL"},{"code":"877141","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878476 = Hospital System Supply Identifier | 877141 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X12MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878477","type":"LOCAL"},{"code":"877142","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878477 = Hospital System Supply Identifier | 877142 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X14MM","code_information":[{"code":"Sx00-1400-261","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878478","type":"LOCAL"},{"code":"877143","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878478 = Hospital System Supply Identifier | 877143 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X26MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878484","type":"LOCAL"},{"code":"877149","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878484 = Hospital System Supply Identifier | 877149 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X20MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878481","type":"LOCAL"},{"code":"877146","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878481 = Hospital System Supply Identifier | 877146 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X22MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878482","type":"LOCAL"},{"code":"877147","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878482 = Hospital System Supply Identifier | 877147 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X24MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878483","type":"LOCAL"},{"code":"877148","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878483 = Hospital System Supply Identifier | 877148 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X28MM","code_information":[{"code":"Sx00-1400-262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878485","type":"LOCAL"},{"code":"877150","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878485 = Hospital System Supply Identifier | 877150 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 2.5X30MM","code_information":[{"code":"Sx00-1400-263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878486","type":"LOCAL"},{"code":"877151","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878486 = Hospital System Supply Identifier | 877151 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X16MM","code_information":[{"code":"Sx00-1400-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878487","type":"LOCAL"},{"code":"877152","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878487 = Hospital System Supply Identifier | 877152 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X18MM","code_information":[{"code":"Sx00-1400-271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878488","type":"LOCAL"},{"code":"877153","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878488 = Hospital System Supply Identifier | 877153 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X20MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878489","type":"LOCAL"},{"code":"877154","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878489 = Hospital System Supply Identifier | 877154 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X22MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878490","type":"LOCAL"},{"code":"877155","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878490 = Hospital System Supply Identifier | 877155 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X24MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878491","type":"LOCAL"},{"code":"877156","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878491 = Hospital System Supply Identifier | 877156 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X26MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878492","type":"LOCAL"},{"code":"877157","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878492 = Hospital System Supply Identifier | 877157 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X28MM","code_information":[{"code":"Sx00-1400-272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878493","type":"LOCAL"},{"code":"877158","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878493 = Hospital System Supply Identifier | 877158 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 2.5X30MM","code_information":[{"code":"Sx00-1400-273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878494","type":"LOCAL"},{"code":"877159","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878494 = Hospital System Supply Identifier | 877159 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X8MM","code_information":[{"code":"Sx00-1400-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878495","type":"LOCAL"},{"code":"877160","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878495 = Hospital System Supply Identifier | 877160 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X18MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878500","type":"LOCAL"},{"code":"877165","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878500 = Hospital System Supply Identifier | 877165 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X16MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878499","type":"LOCAL"},{"code":"877164","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878499 = Hospital System Supply Identifier | 877164 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X10MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878496","type":"LOCAL"},{"code":"877161","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878496 = Hospital System Supply Identifier | 877161 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X12MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878497","type":"LOCAL"},{"code":"877162","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878497 = Hospital System Supply Identifier | 877162 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X14MM","code_information":[{"code":"Sx00-1400-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878498","type":"LOCAL"},{"code":"877163","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878498 = Hospital System Supply Identifier | 877163 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X26MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878504","type":"LOCAL"},{"code":"877169","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878504 = Hospital System Supply Identifier | 877169 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X20MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878501","type":"LOCAL"},{"code":"877166","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878501 = Hospital System Supply Identifier | 877166 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X22MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878502","type":"LOCAL"},{"code":"877167","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878502 = Hospital System Supply Identifier | 877167 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X24MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878503","type":"LOCAL"},{"code":"877168","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878503 = Hospital System Supply Identifier | 877168 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X28MM","code_information":[{"code":"Sx00-1400-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878505","type":"LOCAL"},{"code":"877170","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878505 = Hospital System Supply Identifier | 877170 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X38MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878510","type":"LOCAL"},{"code":"877175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878510 = Hospital System Supply Identifier | 877175 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X34MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878508","type":"LOCAL"},{"code":"877173","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878508 = Hospital System Supply Identifier | 877173 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X36MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878509","type":"LOCAL"},{"code":"877174","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878509 = Hospital System Supply Identifier | 877174 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X32MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878507","type":"LOCAL"},{"code":"877172","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878507 = Hospital System Supply Identifier | 877172 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X30MM","code_information":[{"code":"Sx00-1400-303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878506","type":"LOCAL"},{"code":"877171","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878506 = Hospital System Supply Identifier | 877171 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X40MM","code_information":[{"code":"Sx00-1400-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878511","type":"LOCAL"},{"code":"877176","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878511 = Hospital System Supply Identifier | 877176 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X45MM","code_information":[{"code":"Sx00-1400-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878512","type":"LOCAL"},{"code":"877177","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878512 = Hospital System Supply Identifier | 877177 = Lawson ID"}]},{"description":"SCREW CANN F/T 3.0X50MM","code_information":[{"code":"Sx00-1400-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878513","type":"LOCAL"},{"code":"877178","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878513 = Hospital System Supply Identifier | 877178 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X16MM","code_information":[{"code":"Sx00-1400-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878514","type":"LOCAL"},{"code":"877179","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878514 = Hospital System Supply Identifier | 877179 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X18MM","code_information":[{"code":"Sx00-1400-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878515","type":"LOCAL"},{"code":"877180","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878515 = Hospital System Supply Identifier | 877180 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X28MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878520","type":"LOCAL"},{"code":"877185","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878520 = Hospital System Supply Identifier | 877185 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X24MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878518","type":"LOCAL"},{"code":"877183","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878518 = Hospital System Supply Identifier | 877183 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X26MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878519","type":"LOCAL"},{"code":"877184","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878519 = Hospital System Supply Identifier | 877184 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X20MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878516","type":"LOCAL"},{"code":"877181","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878516 = Hospital System Supply Identifier | 877181 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X22MM","code_information":[{"code":"Sx00-1400-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878517","type":"LOCAL"},{"code":"877182","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878517 = Hospital System Supply Identifier | 877182 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X30MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878521","type":"LOCAL"},{"code":"877186","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878521 = Hospital System Supply Identifier | 877186 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X32MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878522","type":"LOCAL"},{"code":"877187","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878522 = Hospital System Supply Identifier | 877187 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X34MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878523","type":"LOCAL"},{"code":"877188","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878523 = Hospital System Supply Identifier | 877188 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X36MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878524","type":"LOCAL"},{"code":"877189","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878524 = Hospital System Supply Identifier | 877189 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X38MM","code_information":[{"code":"Sx00-1400-313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878525","type":"LOCAL"},{"code":"877190","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878525 = Hospital System Supply Identifier | 877190 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X40MM","code_information":[{"code":"Sx00-1400-314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878526","type":"LOCAL"},{"code":"877191","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878526 = Hospital System Supply Identifier | 877191 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X45MM","code_information":[{"code":"Sx00-1400-314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878527","type":"LOCAL"},{"code":"877192","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878527 = Hospital System Supply Identifier | 877192 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.0X50MM","code_information":[{"code":"Sx00-1400-315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878528","type":"LOCAL"},{"code":"877193","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878528 = Hospital System Supply Identifier | 877193 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X18MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878533","type":"LOCAL"},{"code":"877198","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878533 = Hospital System Supply Identifier | 877198 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X16MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878532","type":"LOCAL"},{"code":"877197","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878532 = Hospital System Supply Identifier | 877197 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X10MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878529","type":"LOCAL"},{"code":"877194","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878529 = Hospital System Supply Identifier | 877194 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X12MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878530","type":"LOCAL"},{"code":"877195","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878530 = Hospital System Supply Identifier | 877195 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X14MM","code_information":[{"code":"Sx00-1400-321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878531","type":"LOCAL"},{"code":"877196","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878531 = Hospital System Supply Identifier | 877196 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X20MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878534","type":"LOCAL"},{"code":"877199","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878534 = Hospital System Supply Identifier | 877199 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X22MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878535","type":"LOCAL"},{"code":"877200","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878535 = Hospital System Supply Identifier | 877200 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X24MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878536","type":"LOCAL"},{"code":"877201","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878536 = Hospital System Supply Identifier | 877201 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X26MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878537","type":"LOCAL"},{"code":"877202","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878537 = Hospital System Supply Identifier | 877202 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X28MM","code_information":[{"code":"Sx00-1400-322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878538","type":"LOCAL"},{"code":"877203","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878538 = Hospital System Supply Identifier | 877203 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X38MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878543","type":"LOCAL"},{"code":"877208","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878543 = Hospital System Supply Identifier | 877208 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X36MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878542","type":"LOCAL"},{"code":"877207","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878542 = Hospital System Supply Identifier | 877207 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X32MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878540","type":"LOCAL"},{"code":"877205","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878540 = Hospital System Supply Identifier | 877205 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X30MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878539","type":"LOCAL"},{"code":"877204","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878539 = Hospital System Supply Identifier | 877204 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X34MM","code_information":[{"code":"Sx00-1400-323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878541","type":"LOCAL"},{"code":"877206","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878541 = Hospital System Supply Identifier | 877206 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X40MM","code_information":[{"code":"Sx00-1400-324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878544","type":"LOCAL"},{"code":"877209","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878544 = Hospital System Supply Identifier | 877209 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X45MM","code_information":[{"code":"Sx00-1400-324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878545","type":"LOCAL"},{"code":"877210","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878545 = Hospital System Supply Identifier | 877210 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.0X50MM","code_information":[{"code":"Sx00-1400-325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878546","type":"LOCAL"},{"code":"877211","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878546 = Hospital System Supply Identifier | 877211 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X16MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878550","type":"LOCAL"},{"code":"877215","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878550 = Hospital System Supply Identifier | 877215 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X18MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878551","type":"LOCAL"},{"code":"877216","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878551 = Hospital System Supply Identifier | 877216 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X14MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878549","type":"LOCAL"},{"code":"877214","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878549 = Hospital System Supply Identifier | 877214 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X10MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878547","type":"LOCAL"},{"code":"877212","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878547 = Hospital System Supply Identifier | 877212 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X12MM","code_information":[{"code":"Sx00-1400-351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878548","type":"LOCAL"},{"code":"877213","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878548 = Hospital System Supply Identifier | 877213 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X20MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878552","type":"LOCAL"},{"code":"877217","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878552 = Hospital System Supply Identifier | 877217 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X22MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878553","type":"LOCAL"},{"code":"877218","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878553 = Hospital System Supply Identifier | 877218 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X24MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878554","type":"LOCAL"},{"code":"877219","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878554 = Hospital System Supply Identifier | 877219 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X26MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878555","type":"LOCAL"},{"code":"877220","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878555 = Hospital System Supply Identifier | 877220 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X28MM","code_information":[{"code":"Sx00-1400-352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878556","type":"LOCAL"},{"code":"877221","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878556 = Hospital System Supply Identifier | 877221 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X30MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878557","type":"LOCAL"},{"code":"877222","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878557 = Hospital System Supply Identifier | 877222 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X32MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878558","type":"LOCAL"},{"code":"877223","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878558 = Hospital System Supply Identifier | 877223 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X34MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878559","type":"LOCAL"},{"code":"877224","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878559 = Hospital System Supply Identifier | 877224 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X36MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878560","type":"LOCAL"},{"code":"877225","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878560 = Hospital System Supply Identifier | 877225 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X38MM","code_information":[{"code":"Sx00-1400-353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878561","type":"LOCAL"},{"code":"877226","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878561 = Hospital System Supply Identifier | 877226 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X48MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878566","type":"LOCAL"},{"code":"877231","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878566 = Hospital System Supply Identifier | 877231 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X40MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878562","type":"LOCAL"},{"code":"877227","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878562 = Hospital System Supply Identifier | 877227 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X42MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878563","type":"LOCAL"},{"code":"877228","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878563 = Hospital System Supply Identifier | 877228 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X44MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878564","type":"LOCAL"},{"code":"877229","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878564 = Hospital System Supply Identifier | 877229 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X46MM","code_information":[{"code":"Sx00-1400-354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878565","type":"LOCAL"},{"code":"877230","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878565 = Hospital System Supply Identifier | 877230 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X55MM","code_information":[{"code":"Sx00-1400-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878568","type":"LOCAL"},{"code":"877233","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878568 = Hospital System Supply Identifier | 877233 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X50MM","code_information":[{"code":"Sx00-1400-355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878567","type":"LOCAL"},{"code":"877232","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878567 = Hospital System Supply Identifier | 877232 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 3.5X60MM","code_information":[{"code":"Sx00-1400-356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878569","type":"LOCAL"},{"code":"877234","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878569 = Hospital System Supply Identifier | 877234 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X16MM","code_information":[{"code":"Sx00-1400-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878570","type":"LOCAL"},{"code":"877235","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878570 = Hospital System Supply Identifier | 877235 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X18MM","code_information":[{"code":"Sx00-1400-361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878571","type":"LOCAL"},{"code":"877236","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878571 = Hospital System Supply Identifier | 877236 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X20MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878572","type":"LOCAL"},{"code":"877237","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878572 = Hospital System Supply Identifier | 877237 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X22MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878573","type":"LOCAL"},{"code":"877238","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878573 = Hospital System Supply Identifier | 877238 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X24MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878574","type":"LOCAL"},{"code":"877239","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878574 = Hospital System Supply Identifier | 877239 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X26MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878575","type":"LOCAL"},{"code":"877240","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878575 = Hospital System Supply Identifier | 877240 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X28MM","code_information":[{"code":"Sx00-1400-362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878576","type":"LOCAL"},{"code":"877241","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878576 = Hospital System Supply Identifier | 877241 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X38MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878581","type":"LOCAL"},{"code":"877246","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878581 = Hospital System Supply Identifier | 877246 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X30MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878577","type":"LOCAL"},{"code":"877242","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878577 = Hospital System Supply Identifier | 877242 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X32MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878578","type":"LOCAL"},{"code":"877243","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878578 = Hospital System Supply Identifier | 877243 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X34MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878579","type":"LOCAL"},{"code":"877244","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878579 = Hospital System Supply Identifier | 877244 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X36MM","code_information":[{"code":"Sx00-1400-363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878580","type":"LOCAL"},{"code":"877245","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878580 = Hospital System Supply Identifier | 877245 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X44MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878584","type":"LOCAL"},{"code":"877249","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878584 = Hospital System Supply Identifier | 877249 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X46MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878585","type":"LOCAL"},{"code":"877250","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878585 = Hospital System Supply Identifier | 877250 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X40MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878582","type":"LOCAL"},{"code":"877247","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878582 = Hospital System Supply Identifier | 877247 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X42MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878583","type":"LOCAL"},{"code":"877248","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878583 = Hospital System Supply Identifier | 877248 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X48MM","code_information":[{"code":"Sx00-1400-364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878586","type":"LOCAL"},{"code":"877251","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878586 = Hospital System Supply Identifier | 877251 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X55MM","code_information":[{"code":"Sx00-1400-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878588","type":"LOCAL"},{"code":"877253","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878588 = Hospital System Supply Identifier | 877253 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X50MM","code_information":[{"code":"Sx00-1400-365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878587","type":"LOCAL"},{"code":"877252","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878587 = Hospital System Supply Identifier | 877252 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 3.5X60MM","code_information":[{"code":"Sx00-1400-366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878589","type":"LOCAL"},{"code":"877254","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878589 = Hospital System Supply Identifier | 877254 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X16MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878593","type":"LOCAL"},{"code":"877258","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878593 = Hospital System Supply Identifier | 877258 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X14MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878592","type":"LOCAL"},{"code":"877257","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878592 = Hospital System Supply Identifier | 877257 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X18MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878594","type":"LOCAL"},{"code":"877259","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878594 = Hospital System Supply Identifier | 877259 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X10MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878590","type":"LOCAL"},{"code":"877255","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878590 = Hospital System Supply Identifier | 877255 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X12MM","code_information":[{"code":"Sx00-1400-371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878591","type":"LOCAL"},{"code":"877256","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878591 = Hospital System Supply Identifier | 877256 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X20MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878595","type":"LOCAL"},{"code":"877260","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878595 = Hospital System Supply Identifier | 877260 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X22MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878596","type":"LOCAL"},{"code":"877261","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878596 = Hospital System Supply Identifier | 877261 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X24MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878597","type":"LOCAL"},{"code":"877262","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878597 = Hospital System Supply Identifier | 877262 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X26MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878598","type":"LOCAL"},{"code":"877263","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878598 = Hospital System Supply Identifier | 877263 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X28MM","code_information":[{"code":"Sx00-1400-372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878599","type":"LOCAL"},{"code":"877264","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878599 = Hospital System Supply Identifier | 877264 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X38MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878604","type":"LOCAL"},{"code":"877269","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878604 = Hospital System Supply Identifier | 877269 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X36MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878603","type":"LOCAL"},{"code":"877268","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878603 = Hospital System Supply Identifier | 877268 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X32MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878601","type":"LOCAL"},{"code":"877266","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878601 = Hospital System Supply Identifier | 877266 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X30MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878600","type":"LOCAL"},{"code":"877265","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878600 = Hospital System Supply Identifier | 877265 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X34MM","code_information":[{"code":"Sx00-1400-373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878602","type":"LOCAL"},{"code":"877267","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878602 = Hospital System Supply Identifier | 877267 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X46MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878608","type":"LOCAL"},{"code":"877273","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878608 = Hospital System Supply Identifier | 877273 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X40MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878605","type":"LOCAL"},{"code":"877270","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878605 = Hospital System Supply Identifier | 877270 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X42MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878606","type":"LOCAL"},{"code":"877271","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878606 = Hospital System Supply Identifier | 877271 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X44MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878607","type":"LOCAL"},{"code":"877272","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878607 = Hospital System Supply Identifier | 877272 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X48MM","code_information":[{"code":"Sx00-1400-374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878609","type":"LOCAL"},{"code":"877274","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878609 = Hospital System Supply Identifier | 877274 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X55MM","code_information":[{"code":"Sx00-1400-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878611","type":"LOCAL"},{"code":"877276","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878611 = Hospital System Supply Identifier | 877276 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X50MM","code_information":[{"code":"Sx00-1400-375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878610","type":"LOCAL"},{"code":"877275","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878610 = Hospital System Supply Identifier | 877275 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 3.5X60MM","code_information":[{"code":"Sx00-1400-376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878612","type":"LOCAL"},{"code":"877277","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878612 = Hospital System Supply Identifier | 877277 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X10MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878613","type":"LOCAL"},{"code":"877278","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878613 = Hospital System Supply Identifier | 877278 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X12MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878614","type":"LOCAL"},{"code":"877279","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878614 = Hospital System Supply Identifier | 877279 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X14MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878615","type":"LOCAL"},{"code":"877280","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878615 = Hospital System Supply Identifier | 877280 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X16MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878616","type":"LOCAL"},{"code":"877281","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878616 = Hospital System Supply Identifier | 877281 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X18MM","code_information":[{"code":"Sx00-1400-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878617","type":"LOCAL"},{"code":"877282","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878617 = Hospital System Supply Identifier | 877282 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X24MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878620","type":"LOCAL"},{"code":"877285","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878620 = Hospital System Supply Identifier | 877285 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X28MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878622","type":"LOCAL"},{"code":"877287","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878622 = Hospital System Supply Identifier | 877287 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X26MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878621","type":"LOCAL"},{"code":"877286","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878621 = Hospital System Supply Identifier | 877286 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X22MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878619","type":"LOCAL"},{"code":"877284","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878619 = Hospital System Supply Identifier | 877284 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X20MM","code_information":[{"code":"Sx00-1400-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878618","type":"LOCAL"},{"code":"877283","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878618 = Hospital System Supply Identifier | 877283 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X30MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878623","type":"LOCAL"},{"code":"877288","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878623 = Hospital System Supply Identifier | 877288 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X32MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878624","type":"LOCAL"},{"code":"877289","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878624 = Hospital System Supply Identifier | 877289 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X34MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878625","type":"LOCAL"},{"code":"877290","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878625 = Hospital System Supply Identifier | 877290 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X36MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878626","type":"LOCAL"},{"code":"877291","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878626 = Hospital System Supply Identifier | 877291 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X38MM","code_information":[{"code":"Sx00-1400-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878627","type":"LOCAL"},{"code":"877292","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878627 = Hospital System Supply Identifier | 877292 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X46MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878631","type":"LOCAL"},{"code":"877296","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878631 = Hospital System Supply Identifier | 877296 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X44MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878630","type":"LOCAL"},{"code":"877295","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878630 = Hospital System Supply Identifier | 877295 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X48MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878632","type":"LOCAL"},{"code":"877297","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878632 = Hospital System Supply Identifier | 877297 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X40MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878628","type":"LOCAL"},{"code":"877293","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878628 = Hospital System Supply Identifier | 877293 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X42MM","code_information":[{"code":"Sx00-1400-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878629","type":"LOCAL"},{"code":"877294","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878629 = Hospital System Supply Identifier | 877294 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X50MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878633","type":"LOCAL"},{"code":"877298","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878633 = Hospital System Supply Identifier | 877298 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X52MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878634","type":"LOCAL"},{"code":"877299","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878634 = Hospital System Supply Identifier | 877299 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X54MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878635","type":"LOCAL"},{"code":"877300","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878635 = Hospital System Supply Identifier | 877300 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X56MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878636","type":"LOCAL"},{"code":"877301","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878636 = Hospital System Supply Identifier | 877301 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X58MM","code_information":[{"code":"Sx00-1400-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878637","type":"LOCAL"},{"code":"877302","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878637 = Hospital System Supply Identifier | 877302 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X60MM","code_information":[{"code":"Sx00-1400-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878638","type":"LOCAL"},{"code":"877303","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878638 = Hospital System Supply Identifier | 877303 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X65MM","code_information":[{"code":"Sx00-1400-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878639","type":"LOCAL"},{"code":"877304","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878639 = Hospital System Supply Identifier | 877304 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.0X70MM","code_information":[{"code":"Sx00-1400-407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878640","type":"LOCAL"},{"code":"877305","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878640 = Hospital System Supply Identifier | 877305 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X16MM","code_information":[{"code":"Sx00-1400-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878641","type":"LOCAL"},{"code":"877306","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878641 = Hospital System Supply Identifier | 877306 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X18MM","code_information":[{"code":"Sx00-1400-411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878642","type":"LOCAL"},{"code":"877307","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878642 = Hospital System Supply Identifier | 877307 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X20MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878643","type":"LOCAL"},{"code":"877308","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878643 = Hospital System Supply Identifier | 877308 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X22MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878644","type":"LOCAL"},{"code":"877309","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878644 = Hospital System Supply Identifier | 877309 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X24MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878645","type":"LOCAL"},{"code":"877310","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878645 = Hospital System Supply Identifier | 877310 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X26MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878646","type":"LOCAL"},{"code":"877311","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878646 = Hospital System Supply Identifier | 877311 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X28MM","code_information":[{"code":"Sx00-1400-412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878647","type":"LOCAL"},{"code":"877312","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878647 = Hospital System Supply Identifier | 877312 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X38MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878652","type":"LOCAL"},{"code":"877317","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878652 = Hospital System Supply Identifier | 877317 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X34MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878650","type":"LOCAL"},{"code":"877315","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878650 = Hospital System Supply Identifier | 877315 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X36MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878651","type":"LOCAL"},{"code":"877316","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878651 = Hospital System Supply Identifier | 877316 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X30MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878648","type":"LOCAL"},{"code":"877313","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878648 = Hospital System Supply Identifier | 877313 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X32MM","code_information":[{"code":"Sx00-1400-413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878649","type":"LOCAL"},{"code":"877314","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878649 = Hospital System Supply Identifier | 877314 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X40MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878653","type":"LOCAL"},{"code":"877318","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878653 = Hospital System Supply Identifier | 877318 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X42MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878654","type":"LOCAL"},{"code":"877319","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878654 = Hospital System Supply Identifier | 877319 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X44MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878655","type":"LOCAL"},{"code":"877320","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878655 = Hospital System Supply Identifier | 877320 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X46MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878656","type":"LOCAL"},{"code":"877321","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878656 = Hospital System Supply Identifier | 877321 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X48MM","code_information":[{"code":"Sx00-1400-414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878657","type":"LOCAL"},{"code":"877322","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878657 = Hospital System Supply Identifier | 877322 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X58MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878662","type":"LOCAL"},{"code":"877327","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878662 = Hospital System Supply Identifier | 877327 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X54MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878660","type":"LOCAL"},{"code":"877325","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878660 = Hospital System Supply Identifier | 877325 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X56MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878661","type":"LOCAL"},{"code":"877326","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878661 = Hospital System Supply Identifier | 877326 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X50MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878658","type":"LOCAL"},{"code":"877323","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878658 = Hospital System Supply Identifier | 877323 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X52MM","code_information":[{"code":"Sx00-1400-415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878659","type":"LOCAL"},{"code":"877324","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878659 = Hospital System Supply Identifier | 877324 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X60MM","code_information":[{"code":"Sx00-1400-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878663","type":"LOCAL"},{"code":"877328","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878663 = Hospital System Supply Identifier | 877328 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X65MM","code_information":[{"code":"Sx00-1400-416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878664","type":"LOCAL"},{"code":"877329","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878664 = Hospital System Supply Identifier | 877329 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.0X70MM","code_information":[{"code":"Sx00-1400-417","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878665","type":"LOCAL"},{"code":"877330","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878665 = Hospital System Supply Identifier | 877330 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED SHORT-THREAD STERILE","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176649","type":"LOCAL"},{"code":"1083674","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176649 = Hospital System Supply Identifier | 1083674 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X10MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878666","type":"LOCAL"},{"code":"877331","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878666 = Hospital System Supply Identifier | 877331 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X12MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878667","type":"LOCAL"},{"code":"877332","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878667 = Hospital System Supply Identifier | 877332 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X16MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878668","type":"LOCAL"},{"code":"877333","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878668 = Hospital System Supply Identifier | 877333 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X18MM","code_information":[{"code":"Sx00-1400-421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878669","type":"LOCAL"},{"code":"877334","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878669 = Hospital System Supply Identifier | 877334 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X26MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878673","type":"LOCAL"},{"code":"877338","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878673 = Hospital System Supply Identifier | 877338 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X24MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878672","type":"LOCAL"},{"code":"877337","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878672 = Hospital System Supply Identifier | 877337 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X28MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878674","type":"LOCAL"},{"code":"877339","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878674 = Hospital System Supply Identifier | 877339 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X20MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878670","type":"LOCAL"},{"code":"877335","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878670 = Hospital System Supply Identifier | 877335 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X22MM","code_information":[{"code":"Sx00-1400-422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878671","type":"LOCAL"},{"code":"877336","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878671 = Hospital System Supply Identifier | 877336 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X30MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878675","type":"LOCAL"},{"code":"877340","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878675 = Hospital System Supply Identifier | 877340 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X32MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878676","type":"LOCAL"},{"code":"877341","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878676 = Hospital System Supply Identifier | 877341 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X34MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878677","type":"LOCAL"},{"code":"877342","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878677 = Hospital System Supply Identifier | 877342 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X36MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878678","type":"LOCAL"},{"code":"877343","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878678 = Hospital System Supply Identifier | 877343 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X38MM","code_information":[{"code":"Sx00-1400-423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878679","type":"LOCAL"},{"code":"877344","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878679 = Hospital System Supply Identifier | 877344 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X48MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878684","type":"LOCAL"},{"code":"877349","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878684 = Hospital System Supply Identifier | 877349 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X46MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878683","type":"LOCAL"},{"code":"877348","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878683 = Hospital System Supply Identifier | 877348 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X44MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878682","type":"LOCAL"},{"code":"877347","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878682 = Hospital System Supply Identifier | 877347 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X42MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878681","type":"LOCAL"},{"code":"877346","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878681 = Hospital System Supply Identifier | 877346 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X40MM","code_information":[{"code":"Sx00-1400-424","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878680","type":"LOCAL"},{"code":"877345","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878680 = Hospital System Supply Identifier | 877345 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X50MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878685","type":"LOCAL"},{"code":"877350","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878685 = Hospital System Supply Identifier | 877350 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X52MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878686","type":"LOCAL"},{"code":"877351","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878686 = Hospital System Supply Identifier | 877351 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X54MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878687","type":"LOCAL"},{"code":"877352","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878687 = Hospital System Supply Identifier | 877352 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X56MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878688","type":"LOCAL"},{"code":"877353","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878688 = Hospital System Supply Identifier | 877353 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X58MM","code_information":[{"code":"Sx00-1400-425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878689","type":"LOCAL"},{"code":"877354","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878689 = Hospital System Supply Identifier | 877354 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X60MM","code_information":[{"code":"Sx00-1400-426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878690","type":"LOCAL"},{"code":"877355","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878690 = Hospital System Supply Identifier | 877355 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X65MM","code_information":[{"code":"Sx00-1400-426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878691","type":"LOCAL"},{"code":"877356","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878691 = Hospital System Supply Identifier | 877356 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.0X70MM","code_information":[{"code":"Sx00-1400-427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878692","type":"LOCAL"},{"code":"877357","type":"LOCAL"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":782.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878692 = Hospital System Supply Identifier | 877357 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X14MM","code_information":[{"code":"Sx00-1400-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878693","type":"LOCAL"},{"code":"877358","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878693 = Hospital System Supply Identifier | 877358 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X16MM","code_information":[{"code":"Sx00-1400-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878694","type":"LOCAL"},{"code":"877359","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878694 = Hospital System Supply Identifier | 877359 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X18MM","code_information":[{"code":"Sx00-1400-451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878695","type":"LOCAL"},{"code":"877360","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878695 = Hospital System Supply Identifier | 877360 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X20MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878696","type":"LOCAL"},{"code":"877361","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878696 = Hospital System Supply Identifier | 877361 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X22MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878697","type":"LOCAL"},{"code":"877362","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878697 = Hospital System Supply Identifier | 877362 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X24MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878698","type":"LOCAL"},{"code":"877363","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878698 = Hospital System Supply Identifier | 877363 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X26MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878699","type":"LOCAL"},{"code":"877364","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878699 = Hospital System Supply Identifier | 877364 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X28MM","code_information":[{"code":"Sx00-1400-452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878700","type":"LOCAL"},{"code":"877365","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878700 = Hospital System Supply Identifier | 877365 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X38MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878705","type":"LOCAL"},{"code":"877370","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878705 = Hospital System Supply Identifier | 877370 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X36MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878704","type":"LOCAL"},{"code":"877369","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878704 = Hospital System Supply Identifier | 877369 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X32MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878702","type":"LOCAL"},{"code":"877367","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878702 = Hospital System Supply Identifier | 877367 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X30MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878701","type":"LOCAL"},{"code":"877366","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878701 = Hospital System Supply Identifier | 877366 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X34MM","code_information":[{"code":"Sx00-1400-453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878703","type":"LOCAL"},{"code":"877368","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878703 = Hospital System Supply Identifier | 877368 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X40MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878706","type":"LOCAL"},{"code":"877371","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878706 = Hospital System Supply Identifier | 877371 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X42MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878707","type":"LOCAL"},{"code":"877372","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878707 = Hospital System Supply Identifier | 877372 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X44MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878708","type":"LOCAL"},{"code":"877373","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878708 = Hospital System Supply Identifier | 877373 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X46MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878709","type":"LOCAL"},{"code":"877374","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878709 = Hospital System Supply Identifier | 877374 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X48MM","code_information":[{"code":"Sx00-1400-454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878710","type":"LOCAL"},{"code":"877375","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878710 = Hospital System Supply Identifier | 877375 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X56MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878714","type":"LOCAL"},{"code":"877379","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878714 = Hospital System Supply Identifier | 877379 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X54MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878713","type":"LOCAL"},{"code":"877378","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878713 = Hospital System Supply Identifier | 877378 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X58MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878715","type":"LOCAL"},{"code":"877380","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878715 = Hospital System Supply Identifier | 877380 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X50MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878711","type":"LOCAL"},{"code":"877376","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878711 = Hospital System Supply Identifier | 877376 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X52MM","code_information":[{"code":"Sx00-1400-455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878712","type":"LOCAL"},{"code":"877377","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878712 = Hospital System Supply Identifier | 877377 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X60MM","code_information":[{"code":"Sx00-1400-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878716","type":"LOCAL"},{"code":"877381","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878716 = Hospital System Supply Identifier | 877381 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X65MM","code_information":[{"code":"Sx00-1400-456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878717","type":"LOCAL"},{"code":"877382","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878717 = Hospital System Supply Identifier | 877382 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X70MM","code_information":[{"code":"Sx00-1400-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878718","type":"LOCAL"},{"code":"877383","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878718 = Hospital System Supply Identifier | 877383 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X75MM","code_information":[{"code":"Sx00-1400-457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878719","type":"LOCAL"},{"code":"877384","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878719 = Hospital System Supply Identifier | 877384 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 4.5X80MM","code_information":[{"code":"Sx00-1400-458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878720","type":"LOCAL"},{"code":"877385","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878720 = Hospital System Supply Identifier | 877385 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X24MM","code_information":[{"code":"Sx00-1400-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878721","type":"LOCAL"},{"code":"877386","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878721 = Hospital System Supply Identifier | 877386 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X26MM","code_information":[{"code":"Sx00-1400-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878722","type":"LOCAL"},{"code":"877387","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878722 = Hospital System Supply Identifier | 877387 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X28MM","code_information":[{"code":"Sx00-1400-462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878723","type":"LOCAL"},{"code":"877388","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878723 = Hospital System Supply Identifier | 877388 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X38MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878729","type":"LOCAL"},{"code":"877393","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878729 = Hospital System Supply Identifier | 877393 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X36MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878728","type":"LOCAL"},{"code":"877392","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878728 = Hospital System Supply Identifier | 877392 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X32MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878726","type":"LOCAL"},{"code":"877390","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878726 = Hospital System Supply Identifier | 877390 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X34MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878727","type":"LOCAL"},{"code":"877391","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878727 = Hospital System Supply Identifier | 877391 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X30MM","code_information":[{"code":"Sx00-1400-463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878724","type":"LOCAL"},{"code":"877389","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878724 = Hospital System Supply Identifier | 877389 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X40MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878730","type":"LOCAL"},{"code":"877394","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878730 = Hospital System Supply Identifier | 877394 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X42MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878731","type":"LOCAL"},{"code":"877395","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878731 = Hospital System Supply Identifier | 877395 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X44MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878732","type":"LOCAL"},{"code":"877396","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878732 = Hospital System Supply Identifier | 877396 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X46MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878733","type":"LOCAL"},{"code":"877397","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878733 = Hospital System Supply Identifier | 877397 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X48MM","code_information":[{"code":"Sx00-1400-464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878734","type":"LOCAL"},{"code":"877398","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878734 = Hospital System Supply Identifier | 877398 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X58MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878739","type":"LOCAL"},{"code":"877403","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878739 = Hospital System Supply Identifier | 877403 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X56MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878738","type":"LOCAL"},{"code":"877402","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878738 = Hospital System Supply Identifier | 877402 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X52MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878736","type":"LOCAL"},{"code":"877400","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878736 = Hospital System Supply Identifier | 877400 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X50MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878735","type":"LOCAL"},{"code":"877399","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878735 = Hospital System Supply Identifier | 877399 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X54MM","code_information":[{"code":"Sx00-1400-465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878737","type":"LOCAL"},{"code":"877401","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878737 = Hospital System Supply Identifier | 877401 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X60MM","code_information":[{"code":"Sx00-1400-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878740","type":"LOCAL"},{"code":"877404","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878740 = Hospital System Supply Identifier | 877404 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X65MM","code_information":[{"code":"Sx00-1400-466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878741","type":"LOCAL"},{"code":"877405","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878741 = Hospital System Supply Identifier | 877405 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X70MM","code_information":[{"code":"Sx00-1400-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878742","type":"LOCAL"},{"code":"877406","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878742 = Hospital System Supply Identifier | 877406 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X75MM","code_information":[{"code":"Sx00-1400-467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878743","type":"LOCAL"},{"code":"877407","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878743 = Hospital System Supply Identifier | 877407 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 4.5X80MM","code_information":[{"code":"Sx00-1400-468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878744","type":"LOCAL"},{"code":"877408","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878744 = Hospital System Supply Identifier | 877408 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X16MM","code_information":[{"code":"Sx00-1400-471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878745","type":"LOCAL"},{"code":"877409","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878745 = Hospital System Supply Identifier | 877409 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X18MM","code_information":[{"code":"Sx00-1400-471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878746","type":"LOCAL"},{"code":"877410","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878746 = Hospital System Supply Identifier | 877410 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X28MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878751","type":"LOCAL"},{"code":"877415","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878751 = Hospital System Supply Identifier | 877415 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X26MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878750","type":"LOCAL"},{"code":"877414","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878750 = Hospital System Supply Identifier | 877414 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X22MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878748","type":"LOCAL"},{"code":"877412","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878748 = Hospital System Supply Identifier | 877412 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X20MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878747","type":"LOCAL"},{"code":"877411","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878747 = Hospital System Supply Identifier | 877411 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X24MM","code_information":[{"code":"Sx00-1400-472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878749","type":"LOCAL"},{"code":"877413","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878749 = Hospital System Supply Identifier | 877413 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X30MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878752","type":"LOCAL"},{"code":"877416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878752 = Hospital System Supply Identifier | 877416 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X32MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878753","type":"LOCAL"},{"code":"877417","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878753 = Hospital System Supply Identifier | 877417 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X34MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878754","type":"LOCAL"},{"code":"877418","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878754 = Hospital System Supply Identifier | 877418 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X36MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878755","type":"LOCAL"},{"code":"877419","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878755 = Hospital System Supply Identifier | 877419 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X38MM","code_information":[{"code":"Sx00-1400-473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878756","type":"LOCAL"},{"code":"877420","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878756 = Hospital System Supply Identifier | 877420 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X48MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878761","type":"LOCAL"},{"code":"877425","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878761 = Hospital System Supply Identifier | 877425 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X46MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878760","type":"LOCAL"},{"code":"877424","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878760 = Hospital System Supply Identifier | 877424 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X40MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878757","type":"LOCAL"},{"code":"877421","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878757 = Hospital System Supply Identifier | 877421 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X42MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878758","type":"LOCAL"},{"code":"877422","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878758 = Hospital System Supply Identifier | 877422 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X44MM","code_information":[{"code":"Sx00-1400-474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878759","type":"LOCAL"},{"code":"877423","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878759 = Hospital System Supply Identifier | 877423 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X50MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878762","type":"LOCAL"},{"code":"877426","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878762 = Hospital System Supply Identifier | 877426 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X52MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878763","type":"LOCAL"},{"code":"877427","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878763 = Hospital System Supply Identifier | 877427 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X54MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878764","type":"LOCAL"},{"code":"877428","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878764 = Hospital System Supply Identifier | 877428 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X56MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878765","type":"LOCAL"},{"code":"877429","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878765 = Hospital System Supply Identifier | 877429 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X58MM","code_information":[{"code":"Sx00-1400-475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878766","type":"LOCAL"},{"code":"877430","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878766 = Hospital System Supply Identifier | 877430 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X60MM","code_information":[{"code":"Sx00-1400-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878767","type":"LOCAL"},{"code":"877431","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878767 = Hospital System Supply Identifier | 877431 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X65MM","code_information":[{"code":"Sx00-1400-476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878768","type":"LOCAL"},{"code":"877432","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878768 = Hospital System Supply Identifier | 877432 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X75MM","code_information":[{"code":"Sx00-1400-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878770","type":"LOCAL"},{"code":"877434","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878770 = Hospital System Supply Identifier | 877434 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 4.5X70MM","code_information":[{"code":"Sx00-1400-477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878769","type":"LOCAL"},{"code":"877433","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878769 = Hospital System Supply Identifier | 877433 = Lawson ID"}]},{"description":"SCREW CANN P/T 4.5X80MM","code_information":[{"code":"Sx00-1400-478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878771","type":"LOCAL"},{"code":"877435","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878771 = Hospital System Supply Identifier | 877435 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X20MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878772","type":"LOCAL"},{"code":"877436","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878772 = Hospital System Supply Identifier | 877436 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X22MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878773","type":"LOCAL"},{"code":"877437","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878773 = Hospital System Supply Identifier | 877437 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X24MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878774","type":"LOCAL"},{"code":"877438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878774 = Hospital System Supply Identifier | 877438 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X26MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878775","type":"LOCAL"},{"code":"877439","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878775 = Hospital System Supply Identifier | 877439 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X28MM","code_information":[{"code":"Sx00-1400-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878776","type":"LOCAL"},{"code":"877440","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878776 = Hospital System Supply Identifier | 877440 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X38MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878781","type":"LOCAL"},{"code":"877445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878781 = Hospital System Supply Identifier | 877445 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X36MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878780","type":"LOCAL"},{"code":"877444","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878780 = Hospital System Supply Identifier | 877444 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X34MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878779","type":"LOCAL"},{"code":"877443","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878779 = Hospital System Supply Identifier | 877443 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X32MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878778","type":"LOCAL"},{"code":"877442","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878778 = Hospital System Supply Identifier | 877442 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X30MM","code_information":[{"code":"Sx00-1400-543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878777","type":"LOCAL"},{"code":"877441","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878777 = Hospital System Supply Identifier | 877441 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X40MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878782","type":"LOCAL"},{"code":"877446","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878782 = Hospital System Supply Identifier | 877446 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X42MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878783","type":"LOCAL"},{"code":"877447","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878783 = Hospital System Supply Identifier | 877447 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X44MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878784","type":"LOCAL"},{"code":"877448","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878784 = Hospital System Supply Identifier | 877448 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X46MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878785","type":"LOCAL"},{"code":"877449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878785 = Hospital System Supply Identifier | 877449 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X48MM","code_information":[{"code":"Sx00-1400-544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878786","type":"LOCAL"},{"code":"877450","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878786 = Hospital System Supply Identifier | 877450 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X50MM","code_information":[{"code":"Sx00-1400-545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878787","type":"LOCAL"},{"code":"877451","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878787 = Hospital System Supply Identifier | 877451 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X55MM","code_information":[{"code":"Sx00-1400-545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878788","type":"LOCAL"},{"code":"877452","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878788 = Hospital System Supply Identifier | 877452 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X65MM","code_information":[{"code":"Sx00-1400-546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878790","type":"LOCAL"},{"code":"877454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878790 = Hospital System Supply Identifier | 877454 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X60MM","code_information":[{"code":"Sx00-1400-546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878789","type":"LOCAL"},{"code":"877453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878789 = Hospital System Supply Identifier | 877453 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X70MM","code_information":[{"code":"Sx00-1400-547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878791","type":"LOCAL"},{"code":"877455","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878791 = Hospital System Supply Identifier | 877455 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X75MM","code_information":[{"code":"Sx00-1400-547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878792","type":"LOCAL"},{"code":"877456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878792 = Hospital System Supply Identifier | 877456 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X80MM","code_information":[{"code":"Sx00-1400-548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878793","type":"LOCAL"},{"code":"877457","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878793 = Hospital System Supply Identifier | 877457 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X85MM","code_information":[{"code":"Sx00-1400-548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878794","type":"LOCAL"},{"code":"877458","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878794 = Hospital System Supply Identifier | 877458 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X90MM","code_information":[{"code":"Sx00-1400-549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878795","type":"LOCAL"},{"code":"877459","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878795 = Hospital System Supply Identifier | 877459 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X95MM","code_information":[{"code":"Sx00-1400-549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878796","type":"LOCAL"},{"code":"877460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878796 = Hospital System Supply Identifier | 877460 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD 5.5X100MM","code_information":[{"code":"Sx00-1400-550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878797","type":"LOCAL"},{"code":"877461","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878797 = Hospital System Supply Identifier | 877461 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X48MM","code_information":[{"code":"Sx00-1400-564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878800","type":"LOCAL"},{"code":"877464","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878800 = Hospital System Supply Identifier | 877464 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X46MM","code_information":[{"code":"Sx00-1400-564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878799","type":"LOCAL"},{"code":"877463","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878799 = Hospital System Supply Identifier | 877463 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X44MM","code_information":[{"code":"Sx00-1400-564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878798","type":"LOCAL"},{"code":"877462","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878798 = Hospital System Supply Identifier | 877462 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X50MM","code_information":[{"code":"Sx00-1400-565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878801","type":"LOCAL"},{"code":"877465","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878801 = Hospital System Supply Identifier | 877465 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X55MM","code_information":[{"code":"Sx00-1400-565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878802","type":"LOCAL"},{"code":"877466","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878802 = Hospital System Supply Identifier | 877466 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X60MM","code_information":[{"code":"Sx00-1400-566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878803","type":"LOCAL"},{"code":"877467","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878803 = Hospital System Supply Identifier | 877467 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X65MM","code_information":[{"code":"Sx00-1400-566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878804","type":"LOCAL"},{"code":"877468","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878804 = Hospital System Supply Identifier | 877468 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X70MM","code_information":[{"code":"Sx00-1400-567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878805","type":"LOCAL"},{"code":"877469","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878805 = Hospital System Supply Identifier | 877469 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X75MM","code_information":[{"code":"Sx00-1400-567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878806","type":"LOCAL"},{"code":"877470","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878806 = Hospital System Supply Identifier | 877470 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X80MM","code_information":[{"code":"Sx00-1400-568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878807","type":"LOCAL"},{"code":"877471","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878807 = Hospital System Supply Identifier | 877471 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X85MM","code_information":[{"code":"Sx00-1400-568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878808","type":"LOCAL"},{"code":"877472","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878808 = Hospital System Supply Identifier | 877472 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X95MM","code_information":[{"code":"Sx00-1400-569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878810","type":"LOCAL"},{"code":"877474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878810 = Hospital System Supply Identifier | 877474 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X90MM","code_information":[{"code":"Sx00-1400-569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878809","type":"LOCAL"},{"code":"877473","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878809 = Hospital System Supply Identifier | 877473 = Lawson ID"}]},{"description":"SCREW CANN MED THRD 5.5X100MM","code_information":[{"code":"Sx00-1400-570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878811","type":"LOCAL"},{"code":"877475","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878811 = Hospital System Supply Identifier | 877475 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X20MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878812","type":"LOCAL"},{"code":"877476","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878812 = Hospital System Supply Identifier | 877476 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X22MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878813","type":"LOCAL"},{"code":"877477","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878813 = Hospital System Supply Identifier | 877477 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X24MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878814","type":"LOCAL"},{"code":"877478","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878814 = Hospital System Supply Identifier | 877478 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X26MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878815","type":"LOCAL"},{"code":"877479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878815 = Hospital System Supply Identifier | 877479 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X28MM","code_information":[{"code":"Sx00-1400-582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878816","type":"LOCAL"},{"code":"877480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878816 = Hospital System Supply Identifier | 877480 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X38MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878821","type":"LOCAL"},{"code":"877485","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878821 = Hospital System Supply Identifier | 877485 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X36MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878820","type":"LOCAL"},{"code":"877484","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878820 = Hospital System Supply Identifier | 877484 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X34MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878819","type":"LOCAL"},{"code":"877483","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878819 = Hospital System Supply Identifier | 877483 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X32MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878818","type":"LOCAL"},{"code":"877482","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878818 = Hospital System Supply Identifier | 877482 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X30MM","code_information":[{"code":"Sx00-1400-583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878817","type":"LOCAL"},{"code":"877481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878817 = Hospital System Supply Identifier | 877481 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X40MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878822","type":"LOCAL"},{"code":"877486","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878822 = Hospital System Supply Identifier | 877486 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X42MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878823","type":"LOCAL"},{"code":"877487","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878823 = Hospital System Supply Identifier | 877487 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X44MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878824","type":"LOCAL"},{"code":"877488","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878824 = Hospital System Supply Identifier | 877488 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X46MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878825","type":"LOCAL"},{"code":"877489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878825 = Hospital System Supply Identifier | 877489 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X48MM","code_information":[{"code":"Sx00-1400-584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878826","type":"LOCAL"},{"code":"877490","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878826 = Hospital System Supply Identifier | 877490 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X50MM","code_information":[{"code":"Sx00-1400-585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878827","type":"LOCAL"},{"code":"877491","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878827 = Hospital System Supply Identifier | 877491 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X55MM","code_information":[{"code":"Sx00-1400-585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878828","type":"LOCAL"},{"code":"877492","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878828 = Hospital System Supply Identifier | 877492 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X65MM","code_information":[{"code":"Sx00-1400-586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878830","type":"LOCAL"},{"code":"877494","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878830 = Hospital System Supply Identifier | 877494 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X60MM","code_information":[{"code":"Sx00-1400-586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878829","type":"LOCAL"},{"code":"877493","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878829 = Hospital System Supply Identifier | 877493 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X70MM","code_information":[{"code":"Sx00-1400-587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878831","type":"LOCAL"},{"code":"877495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878831 = Hospital System Supply Identifier | 877495 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X75MM","code_information":[{"code":"Sx00-1400-587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878832","type":"LOCAL"},{"code":"877496","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878832 = Hospital System Supply Identifier | 877496 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X80MM","code_information":[{"code":"Sx00-1400-588","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878833","type":"LOCAL"},{"code":"877497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878833 = Hospital System Supply Identifier | 877497 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X85MM","code_information":[{"code":"Sx00-1400-588","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878834","type":"LOCAL"},{"code":"877498","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878834 = Hospital System Supply Identifier | 877498 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X90MM","code_information":[{"code":"Sx00-1400-589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878835","type":"LOCAL"},{"code":"877499","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878835 = Hospital System Supply Identifier | 877499 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X95MM","code_information":[{"code":"Sx00-1400-589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878836","type":"LOCAL"},{"code":"877500","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878836 = Hospital System Supply Identifier | 877500 = Lawson ID"}]},{"description":"SCREW CANN SHRT THRD 5.5X100MM","code_information":[{"code":"Sx00-1400-590","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878837","type":"LOCAL"},{"code":"877501","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878837 = Hospital System Supply Identifier | 877501 = Lawson ID"}]},{"description":"SCREW-WASHER CANN 6.5/7.3MM","code_information":[{"code":"Sx00-1402-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878838","type":"LOCAL"},{"code":"877502","type":"LOCAL"}],"standard_charges":[{"gross_charge":427.5,"discounted_cash":299.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878838 = Hospital System Supply Identifier | 877502 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X35","code_information":[{"code":"Sx00-1402-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878840","type":"LOCAL"},{"code":"877504","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878840 = Hospital System Supply Identifier | 877504 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X30","code_information":[{"code":"Sx00-1402-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878839","type":"LOCAL"},{"code":"877503","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878839 = Hospital System Supply Identifier | 877503 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X40","code_information":[{"code":"Sx00-1402-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878841","type":"LOCAL"},{"code":"877505","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878841 = Hospital System Supply Identifier | 877505 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X45","code_information":[{"code":"Sx00-1402-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878842","type":"LOCAL"},{"code":"877506","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878842 = Hospital System Supply Identifier | 877506 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X50","code_information":[{"code":"Sx00-1402-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878843","type":"LOCAL"},{"code":"877507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878843 = Hospital System Supply Identifier | 877507 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X55","code_information":[{"code":"Sx00-1402-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878844","type":"LOCAL"},{"code":"877508","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878844 = Hospital System Supply Identifier | 877508 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 7.3X60","code_information":[{"code":"Sx00-1402-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878846","type":"LOCAL"},{"code":"877509","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878846 = Hospital System Supply Identifier | 877509 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X65","code_information":[{"code":"Sx00-1402-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878847","type":"LOCAL"},{"code":"877510","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878847 = Hospital System Supply Identifier | 877510 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X75","code_information":[{"code":"Sx00-1402-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878849","type":"LOCAL"},{"code":"877512","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878849 = Hospital System Supply Identifier | 877512 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X70","code_information":[{"code":"Sx00-1402-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878848","type":"LOCAL"},{"code":"877511","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878848 = Hospital System Supply Identifier | 877511 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X85","code_information":[{"code":"Sx00-1402-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878851","type":"LOCAL"},{"code":"877514","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878851 = Hospital System Supply Identifier | 877514 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X80","code_information":[{"code":"Sx00-1402-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878850","type":"LOCAL"},{"code":"877513","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878850 = Hospital System Supply Identifier | 877513 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 7.3X90","code_information":[{"code":"Sx00-1402-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878852","type":"LOCAL"},{"code":"877515","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878852 = Hospital System Supply Identifier | 877515 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X95","code_information":[{"code":"Sx00-1402-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878854","type":"LOCAL"},{"code":"877516","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878854 = Hospital System Supply Identifier | 877516 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X100","code_information":[{"code":"Sx00-1402-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878855","type":"LOCAL"},{"code":"877517","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878855 = Hospital System Supply Identifier | 877517 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X105","code_information":[{"code":"Sx00-1402-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878856","type":"LOCAL"},{"code":"877518","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878856 = Hospital System Supply Identifier | 877518 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X110","code_information":[{"code":"Sx00-1402-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878857","type":"LOCAL"},{"code":"877519","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878857 = Hospital System Supply Identifier | 877519 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X115","code_information":[{"code":"Sx00-1402-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878858","type":"LOCAL"},{"code":"877520","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878858 = Hospital System Supply Identifier | 877520 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X125","code_information":[{"code":"Sx00-1402-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878860","type":"LOCAL"},{"code":"877522","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878860 = Hospital System Supply Identifier | 877522 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X120","code_information":[{"code":"Sx00-1402-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878859","type":"LOCAL"},{"code":"877521","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878859 = Hospital System Supply Identifier | 877521 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 7.3X130","code_information":[{"code":"Sx00-1402-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878861","type":"LOCAL"},{"code":"877523","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878861 = Hospital System Supply Identifier | 877523 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X38","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878866","type":"LOCAL"},{"code":"877528","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878866 = Hospital System Supply Identifier | 877528 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X36","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878865","type":"LOCAL"},{"code":"877527","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878865 = Hospital System Supply Identifier | 877527 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X30","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878862","type":"LOCAL"},{"code":"877524","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878862 = Hospital System Supply Identifier | 877524 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X32","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878863","type":"LOCAL"},{"code":"877525","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878863 = Hospital System Supply Identifier | 877525 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X34","code_information":[{"code":"Sx00-1402-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878864","type":"LOCAL"},{"code":"877526","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878864 = Hospital System Supply Identifier | 877526 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X40","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878867","type":"LOCAL"},{"code":"877529","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878867 = Hospital System Supply Identifier | 877529 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X42","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878868","type":"LOCAL"},{"code":"877530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878868 = Hospital System Supply Identifier | 877530 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X44","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878869","type":"LOCAL"},{"code":"877531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878869 = Hospital System Supply Identifier | 877531 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X46","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878870","type":"LOCAL"},{"code":"877532","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878870 = Hospital System Supply Identifier | 877532 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X48","code_information":[{"code":"Sx00-1402-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878871","type":"LOCAL"},{"code":"877533","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878871 = Hospital System Supply Identifier | 877533 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X50","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878872","type":"LOCAL"},{"code":"877534","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878872 = Hospital System Supply Identifier | 877534 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X52","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878873","type":"LOCAL"},{"code":"877535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878873 = Hospital System Supply Identifier | 877535 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X54","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878874","type":"LOCAL"},{"code":"877536","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878874 = Hospital System Supply Identifier | 877536 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X56","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878875","type":"LOCAL"},{"code":"877537","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878875 = Hospital System Supply Identifier | 877537 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X58","code_information":[{"code":"Sx00-1402-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878876","type":"LOCAL"},{"code":"877538","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878876 = Hospital System Supply Identifier | 877538 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X66","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878880","type":"LOCAL"},{"code":"877542","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878880 = Hospital System Supply Identifier | 877542 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X64","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878879","type":"LOCAL"},{"code":"877541","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878879 = Hospital System Supply Identifier | 877541 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X68","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878881","type":"LOCAL"},{"code":"877543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878881 = Hospital System Supply Identifier | 877543 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X60","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878877","type":"LOCAL"},{"code":"877539","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878877 = Hospital System Supply Identifier | 877539 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X62","code_information":[{"code":"Sx00-1402-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878878","type":"LOCAL"},{"code":"877540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878878 = Hospital System Supply Identifier | 877540 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X78","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878886","type":"LOCAL"},{"code":"877548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878886 = Hospital System Supply Identifier | 877548 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X76","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878885","type":"LOCAL"},{"code":"877547","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878885 = Hospital System Supply Identifier | 877547 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X70","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878882","type":"LOCAL"},{"code":"877544","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878882 = Hospital System Supply Identifier | 877544 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X72","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878883","type":"LOCAL"},{"code":"877545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878883 = Hospital System Supply Identifier | 877545 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X74","code_information":[{"code":"Sx00-1402-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878884","type":"LOCAL"},{"code":"877546","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878884 = Hospital System Supply Identifier | 877546 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X80","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878887","type":"LOCAL"},{"code":"877549","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878887 = Hospital System Supply Identifier | 877549 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X82","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878888","type":"LOCAL"},{"code":"877550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878888 = Hospital System Supply Identifier | 877550 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X84","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878889","type":"LOCAL"},{"code":"877551","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878889 = Hospital System Supply Identifier | 877551 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X86","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878890","type":"LOCAL"},{"code":"877552","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878890 = Hospital System Supply Identifier | 877552 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X88","code_information":[{"code":"Sx00-1402-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878891","type":"LOCAL"},{"code":"877553","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878891 = Hospital System Supply Identifier | 877553 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X90","code_information":[{"code":"Sx00-1402-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878892","type":"LOCAL"},{"code":"877554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878892 = Hospital System Supply Identifier | 877554 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 7.3X95","code_information":[{"code":"Sx00-1402-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878893","type":"LOCAL"},{"code":"877555","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878893 = Hospital System Supply Identifier | 877555 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X105","code_information":[{"code":"Sx00-1402-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878895","type":"LOCAL"},{"code":"877557","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878895 = Hospital System Supply Identifier | 877557 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X100","code_information":[{"code":"Sx00-1402-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878894","type":"LOCAL"},{"code":"877556","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878894 = Hospital System Supply Identifier | 877556 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X110","code_information":[{"code":"Sx00-1402-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878896","type":"LOCAL"},{"code":"877558","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878896 = Hospital System Supply Identifier | 877558 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X115","code_information":[{"code":"Sx00-1402-211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878897","type":"LOCAL"},{"code":"877559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878897 = Hospital System Supply Identifier | 877559 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X120","code_information":[{"code":"Sx00-1402-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878898","type":"LOCAL"},{"code":"877560","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878898 = Hospital System Supply Identifier | 877560 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X125","code_information":[{"code":"Sx00-1402-212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878899","type":"LOCAL"},{"code":"877561","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878899 = Hospital System Supply Identifier | 877561 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS7.3X130","code_information":[{"code":"Sx00-1402-213","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878900","type":"LOCAL"},{"code":"877562","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878900 = Hospital System Supply Identifier | 877562 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X30","code_information":[{"code":"Sx00-1402-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878901","type":"LOCAL"},{"code":"877563","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878901 = Hospital System Supply Identifier | 877563 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X35","code_information":[{"code":"Sx00-1402-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878902","type":"LOCAL"},{"code":"877564","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878902 = Hospital System Supply Identifier | 877564 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X45","code_information":[{"code":"Sx00-1402-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878904","type":"LOCAL"},{"code":"877566","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878904 = Hospital System Supply Identifier | 877566 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X40","code_information":[{"code":"Sx00-1402-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878903","type":"LOCAL"},{"code":"877565","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878903 = Hospital System Supply Identifier | 877565 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X50","code_information":[{"code":"Sx00-1402-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878905","type":"LOCAL"},{"code":"877567","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878905 = Hospital System Supply Identifier | 877567 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X55","code_information":[{"code":"Sx00-1402-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878906","type":"LOCAL"},{"code":"877568","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878906 = Hospital System Supply Identifier | 877568 = Lawson ID"}]},{"description":"SCREW CANN 16 SHRT THRD 6.5X60","code_information":[{"code":"Sx00-1402-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878907","type":"LOCAL"},{"code":"877569","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878907 = Hospital System Supply Identifier | 877569 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X65","code_information":[{"code":"Sx00-1402-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878908","type":"LOCAL"},{"code":"877570","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878908 = Hospital System Supply Identifier | 877570 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X70","code_information":[{"code":"Sx00-1402-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878909","type":"LOCAL"},{"code":"877571","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878909 = Hospital System Supply Identifier | 877571 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X75","code_information":[{"code":"Sx00-1402-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878910","type":"LOCAL"},{"code":"877572","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878910 = Hospital System Supply Identifier | 877572 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X80","code_information":[{"code":"Sx00-1402-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878911","type":"LOCAL"},{"code":"877573","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878911 = Hospital System Supply Identifier | 877573 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X85","code_information":[{"code":"Sx00-1402-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878912","type":"LOCAL"},{"code":"877574","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878912 = Hospital System Supply Identifier | 877574 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X95","code_information":[{"code":"Sx00-1402-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878914","type":"LOCAL"},{"code":"877576","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878914 = Hospital System Supply Identifier | 877576 = Lawson ID"}]},{"description":"DISC - SCREW CANN 24 MED THRD 6.5X90","code_information":[{"code":"Sx00-1402-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878913","type":"LOCAL"},{"code":"877575","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878913 = Hospital System Supply Identifier | 877575 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X100","code_information":[{"code":"Sx00-1402-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878915","type":"LOCAL"},{"code":"877577","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878915 = Hospital System Supply Identifier | 877577 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X105","code_information":[{"code":"Sx00-1402-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878916","type":"LOCAL"},{"code":"877578","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878916 = Hospital System Supply Identifier | 877578 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X110","code_information":[{"code":"Sx00-1402-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878917","type":"LOCAL"},{"code":"877579","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878917 = Hospital System Supply Identifier | 877579 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X115","code_information":[{"code":"Sx00-1402-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878918","type":"LOCAL"},{"code":"877580","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878918 = Hospital System Supply Identifier | 877580 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X120","code_information":[{"code":"Sx00-1402-512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878919","type":"LOCAL"},{"code":"877581","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878919 = Hospital System Supply Identifier | 877581 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X125","code_information":[{"code":"Sx00-1402-512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878920","type":"LOCAL"},{"code":"877582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878920 = Hospital System Supply Identifier | 877582 = Lawson ID"}]},{"description":"SCREW CANN 32 LNG THRD 6.5X130","code_information":[{"code":"Sx00-1402-513","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878921","type":"LOCAL"},{"code":"877583","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878921 = Hospital System Supply Identifier | 877583 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X38","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878926","type":"LOCAL"},{"code":"877588","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878926 = Hospital System Supply Identifier | 877588 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X36","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878925","type":"LOCAL"},{"code":"877587","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878925 = Hospital System Supply Identifier | 877587 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X34","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878924","type":"LOCAL"},{"code":"877586","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878924 = Hospital System Supply Identifier | 877586 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X32","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878923","type":"LOCAL"},{"code":"877585","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878923 = Hospital System Supply Identifier | 877585 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X30","code_information":[{"code":"Sx00-1402-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878922","type":"LOCAL"},{"code":"877584","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878922 = Hospital System Supply Identifier | 877584 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X40","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878927","type":"LOCAL"},{"code":"877589","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878927 = Hospital System Supply Identifier | 877589 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X42","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878928","type":"LOCAL"},{"code":"877590","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878928 = Hospital System Supply Identifier | 877590 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X44","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878929","type":"LOCAL"},{"code":"877591","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878929 = Hospital System Supply Identifier | 877591 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X46","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878930","type":"LOCAL"},{"code":"877592","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878930 = Hospital System Supply Identifier | 877592 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X48","code_information":[{"code":"Sx00-1402-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878931","type":"LOCAL"},{"code":"877593","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878931 = Hospital System Supply Identifier | 877593 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X58","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878936","type":"LOCAL"},{"code":"877598","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878936 = Hospital System Supply Identifier | 877598 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X56","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878935","type":"LOCAL"},{"code":"877597","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878935 = Hospital System Supply Identifier | 877597 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X54","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878934","type":"LOCAL"},{"code":"877596","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878934 = Hospital System Supply Identifier | 877596 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X52","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878933","type":"LOCAL"},{"code":"877595","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878933 = Hospital System Supply Identifier | 877595 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X50","code_information":[{"code":"Sx00-1402-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878932","type":"LOCAL"},{"code":"877594","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878932 = Hospital System Supply Identifier | 877594 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X60","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878937","type":"LOCAL"},{"code":"877599","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878937 = Hospital System Supply Identifier | 877599 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X62","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878938","type":"LOCAL"},{"code":"877600","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878938 = Hospital System Supply Identifier | 877600 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X64","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878939","type":"LOCAL"},{"code":"877601","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878939 = Hospital System Supply Identifier | 877601 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X66","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878940","type":"LOCAL"},{"code":"877602","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878940 = Hospital System Supply Identifier | 877602 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X68","code_information":[{"code":"Sx00-1402-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878941","type":"LOCAL"},{"code":"877603","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878941 = Hospital System Supply Identifier | 877603 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X78","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878946","type":"LOCAL"},{"code":"877608","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878946 = Hospital System Supply Identifier | 877608 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X76","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878945","type":"LOCAL"},{"code":"877607","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878945 = Hospital System Supply Identifier | 877607 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X74","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878944","type":"LOCAL"},{"code":"877606","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878944 = Hospital System Supply Identifier | 877606 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X72","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878943","type":"LOCAL"},{"code":"877605","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878943 = Hospital System Supply Identifier | 877605 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X70","code_information":[{"code":"Sx00-1402-607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878942","type":"LOCAL"},{"code":"877604","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878942 = Hospital System Supply Identifier | 877604 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X80","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878947","type":"LOCAL"},{"code":"877609","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878947 = Hospital System Supply Identifier | 877609 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X82","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878948","type":"LOCAL"},{"code":"877610","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878948 = Hospital System Supply Identifier | 877610 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X84","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878949","type":"LOCAL"},{"code":"877611","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878949 = Hospital System Supply Identifier | 877611 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X86","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878950","type":"LOCAL"},{"code":"877612","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878950 = Hospital System Supply Identifier | 877612 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X88","code_information":[{"code":"Sx00-1402-608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878951","type":"LOCAL"},{"code":"877613","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878951 = Hospital System Supply Identifier | 877613 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X90","code_information":[{"code":"Sx00-1402-609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878952","type":"LOCAL"},{"code":"877614","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878952 = Hospital System Supply Identifier | 877614 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS 6.5X95","code_information":[{"code":"Sx00-1402-609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878953","type":"LOCAL"},{"code":"877615","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878953 = Hospital System Supply Identifier | 877615 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X105","code_information":[{"code":"Sx00-1402-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878955","type":"LOCAL"},{"code":"877617","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878955 = Hospital System Supply Identifier | 877617 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X100","code_information":[{"code":"Sx00-1402-610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878954","type":"LOCAL"},{"code":"877616","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878954 = Hospital System Supply Identifier | 877616 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X110","code_information":[{"code":"Sx00-1402-611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878956","type":"LOCAL"},{"code":"877618","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878956 = Hospital System Supply Identifier | 877618 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X115","code_information":[{"code":"Sx00-1402-611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878957","type":"LOCAL"},{"code":"877619","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878957 = Hospital System Supply Identifier | 877619 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X120","code_information":[{"code":"Sx00-1402-612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878958","type":"LOCAL"},{"code":"877620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878958 = Hospital System Supply Identifier | 877620 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X125","code_information":[{"code":"Sx00-1402-612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878959","type":"LOCAL"},{"code":"877621","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878959 = Hospital System Supply Identifier | 877621 = Lawson ID"}]},{"description":"SCREW CANN FULL THRD SS6.5X130","code_information":[{"code":"Sx00-1402-613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878960","type":"LOCAL"},{"code":"877622","type":"LOCAL"}],"standard_charges":[{"gross_charge":1483.5,"discounted_cash":1038.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878960 = Hospital System Supply Identifier | 877622 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026345 SS 6.5X45MM","code_information":[{"code":"Sx00-1402-634","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176668","type":"LOCAL"},{"code":"1082486","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176668 = Hospital System Supply Identifier | 1082486 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026355 SS 6.5X55MM","code_information":[{"code":"Sx00-1402-635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175758","type":"LOCAL"},{"code":"1082535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175758 = Hospital System Supply Identifier | 1082535 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175941","type":"LOCAL"},{"code":"1083660","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175941 = Hospital System Supply Identifier | 1083660 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176281","type":"LOCAL"},{"code":"1083704","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176281 = Hospital System Supply Identifier | 1083704 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026365 SS 6.5X65MM","code_information":[{"code":"Sx00-1402-636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176160","type":"LOCAL"},{"code":"1082540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176160 = Hospital System Supply Identifier | 1082540 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026375 SS 6.5X75MM","code_information":[{"code":"Sx00-1402-637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176055","type":"LOCAL"},{"code":"1082532","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176055 = Hospital System Supply Identifier | 1082532 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026370 SS 6.5X70MM","code_information":[{"code":"Sx00-1402-637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176266","type":"LOCAL"},{"code":"1082597","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176266 = Hospital System Supply Identifier | 1082597 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026385 SS 6.5X85MM","code_information":[{"code":"Sx00-1402-638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176337","type":"LOCAL"},{"code":"1082513","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176337 = Hospital System Supply Identifier | 1082513 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026380 SS 6.5X80MM","code_information":[{"code":"Sx00-1402-638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176477","type":"LOCAL"},{"code":"1082559","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176477 = Hospital System Supply Identifier | 1082559 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014026390 SS 6.5X90MM","code_information":[{"code":"Sx00-1402-639","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176391","type":"LOCAL"},{"code":"1082507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176391 = Hospital System Supply Identifier | 1082507 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027065 SS 7.3X65MM","code_information":[{"code":"Sx00-1402-706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176157","type":"LOCAL"},{"code":"1082443","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176157 = Hospital System Supply Identifier | 1082443 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027070 SS 7.3X70MM","code_information":[{"code":"Sx00-1402-707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175853","type":"LOCAL"},{"code":"1082456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175853 = Hospital System Supply Identifier | 1082456 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027075 SS 7.3X75MM","code_information":[{"code":"Sx00-1402-707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176459","type":"LOCAL"},{"code":"1082521","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176459 = Hospital System Supply Identifier | 1082521 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175925","type":"LOCAL"},{"code":"1083619","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175925 = Hospital System Supply Identifier | 1083619 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027085 SS 7.3X85MM","code_information":[{"code":"Sx00-1402-708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176393","type":"LOCAL"},{"code":"1082545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176393 = Hospital System Supply Identifier | 1082545 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027095 SS 7.3X95MM","code_information":[{"code":"Sx00-1402-709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176038","type":"LOCAL"},{"code":"1082428","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176038 = Hospital System Supply Identifier | 1082428 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175804","type":"LOCAL"},{"code":"1083550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175804 = Hospital System Supply Identifier | 1083550 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027100 SS 7.3X100MM","code_information":[{"code":"Sx00-1402-710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176062","type":"LOCAL"},{"code":"1082474","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176062 = Hospital System Supply Identifier | 1082474 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027105 SS 7.3X105MM","code_information":[{"code":"Sx00-1402-710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176139","type":"LOCAL"},{"code":"1082581","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176139 = Hospital System Supply Identifier | 1082581 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027110 SS 7.3X110MM","code_information":[{"code":"Sx00-1402-711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175981","type":"LOCAL"},{"code":"1082449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175981 = Hospital System Supply Identifier | 1082449 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027115 SS 7.3X115MM","code_information":[{"code":"Sx00-1402-711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176018","type":"LOCAL"},{"code":"1082543","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176018 = Hospital System Supply Identifier | 1082543 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027120 SS 7.3X120MM","code_information":[{"code":"Sx00-1402-712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175929","type":"LOCAL"},{"code":"1082432","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175929 = Hospital System Supply Identifier | 1082432 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027125 SS 7.3X125MM","code_information":[{"code":"Sx00-1402-712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176039","type":"LOCAL"},{"code":"1082445","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176039 = Hospital System Supply Identifier | 1082445 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014027130 SS 7.3X130MM","code_information":[{"code":"Sx00-1402-713","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176506","type":"LOCAL"},{"code":"1082554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176506 = Hospital System Supply Identifier | 1082554 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027345 SS 7.3X45MM","code_information":[{"code":"Sx00-1402-734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176133","type":"LOCAL"},{"code":"1082530","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176133 = Hospital System Supply Identifier | 1082530 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027350 SS 7.3X50MM","code_information":[{"code":"Sx00-1402-735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176504","type":"LOCAL"},{"code":"1082509","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176504 = Hospital System Supply Identifier | 1082509 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027355 SS 7.3X55MM","code_information":[{"code":"Sx00-1402-735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176537","type":"LOCAL"},{"code":"1082517","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176537 = Hospital System Supply Identifier | 1082517 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027365 SS 7.3X65MM","code_information":[{"code":"Sx00-1402-736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175800","type":"LOCAL"},{"code":"1082476","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175800 = Hospital System Supply Identifier | 1082476 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027360 SS 7.3X60MM","code_information":[{"code":"Sx00-1402-736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176119","type":"LOCAL"},{"code":"1082595","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176119 = Hospital System Supply Identifier | 1082595 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176272","type":"LOCAL"},{"code":"1083727","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176272 = Hospital System Supply Identifier | 1083727 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176650","type":"LOCAL"},{"code":"1083728","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176650 = Hospital System Supply Identifier | 1083728 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED LONG THREAD 0014027385 SS 7.3X85MM","code_information":[{"code":"Sx00-1402-738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176032","type":"LOCAL"},{"code":"1082504","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176032 = Hospital System Supply Identifier | 1082504 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176172","type":"LOCAL"},{"code":"1083554","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176172 = Hospital System Supply Identifier | 1083554 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL LONG-THREAD FEMUR","code_information":[{"code":"Sx00-1402-739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176047","type":"LOCAL"},{"code":"1083548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176047 = Hospital System Supply Identifier | 1083548 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028065 SS 6.5X65MM","code_information":[{"code":"Sx00-1402-806","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176115","type":"LOCAL"},{"code":"1082566","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176115 = Hospital System Supply Identifier | 1082566 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028070 SS 6.5X70MM","code_information":[{"code":"Sx00-1402-807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175997","type":"LOCAL"},{"code":"1082550","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175997 = Hospital System Supply Identifier | 1082550 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175770","type":"LOCAL"},{"code":"1083712","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175770 = Hospital System Supply Identifier | 1083712 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175945","type":"LOCAL"},{"code":"1083556","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175945 = Hospital System Supply Identifier | 1083556 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175914","type":"LOCAL"},{"code":"1083658","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175914 = Hospital System Supply Identifier | 1083658 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028095 SS 6.5X95MM","code_information":[{"code":"Sx00-1402-809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176260","type":"LOCAL"},{"code":"1082480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176260 = Hospital System Supply Identifier | 1082480 = Lawson ID"}]},{"description":"SCREW-BONE CANNULATED STAINLESS-STEEL 16MM-SHORT-THREAD FEMUR","code_information":[{"code":"Sx00-1402-809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176284","type":"LOCAL"},{"code":"1083535","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176284 = Hospital System Supply Identifier | 1083535 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028105 SS 6.5X105MM","code_information":[{"code":"Sx00-1402-810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176418","type":"LOCAL"},{"code":"1082485","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176418 = Hospital System Supply Identifier | 1082485 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028100 SS 6.5X100MM","code_information":[{"code":"Sx00-1402-810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176361","type":"LOCAL"},{"code":"1082560","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176361 = Hospital System Supply Identifier | 1082560 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028115 SS 6.5X115MM","code_information":[{"code":"Sx00-1402-811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176410","type":"LOCAL"},{"code":"1082460","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176410 = Hospital System Supply Identifier | 1082460 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028110 SS 6.5X110MM","code_information":[{"code":"Sx00-1402-811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176386","type":"LOCAL"},{"code":"1082441","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176386 = Hospital System Supply Identifier | 1082441 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028120 SS 6.5X120MM","code_information":[{"code":"Sx00-1402-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176455","type":"LOCAL"},{"code":"1082431","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176455 = Hospital System Supply Identifier | 1082431 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028125 SS 6.5X125MM","code_information":[{"code":"Sx00-1402-812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176225","type":"LOCAL"},{"code":"1082430","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176225 = Hospital System Supply Identifier | 1082430 = Lawson ID"}]},{"description":"SCREW BONE CANNULATED SHORT THREAD 0014028130 SS 6.5X130MM","code_information":[{"code":"Sx00-1402-813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176099","type":"LOCAL"},{"code":"1082457","type":"LOCAL"}],"standard_charges":[{"gross_charge":1393.2,"discounted_cash":975.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176099 = Hospital System Supply Identifier | 1082457 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X200MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878961","type":"LOCAL"},{"code":"877623","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878961 = Hospital System Supply Identifier | 877623 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X220MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878962","type":"LOCAL"},{"code":"877624","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878962 = Hospital System Supply Identifier | 877624 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X240MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878963","type":"LOCAL"},{"code":"877625","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878963 = Hospital System Supply Identifier | 877625 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X260MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878964","type":"LOCAL"},{"code":"877626","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878964 = Hospital System Supply Identifier | 877626 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X280MM LT","code_information":[{"code":"Sx00-1501-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878965","type":"LOCAL"},{"code":"877627","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878965 = Hospital System Supply Identifier | 877627 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X380MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878970","type":"LOCAL"},{"code":"877632","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878970 = Hospital System Supply Identifier | 877632 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X340MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878968","type":"LOCAL"},{"code":"877630","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878968 = Hospital System Supply Identifier | 877630 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X360MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878969","type":"LOCAL"},{"code":"877631","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878969 = Hospital System Supply Identifier | 877631 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X300MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878966","type":"LOCAL"},{"code":"877628","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878966 = Hospital System Supply Identifier | 877628 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X320MM LT","code_information":[{"code":"Sx00-1501-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878967","type":"LOCAL"},{"code":"877629","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878967 = Hospital System Supply Identifier | 877629 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X240MM LT","code_information":[{"code":"Sx00-1501-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878971","type":"LOCAL"},{"code":"877633","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878971 = Hospital System Supply Identifier | 877633 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X260MM LT","code_information":[{"code":"Sx00-1501-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878972","type":"LOCAL"},{"code":"877634","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878972 = Hospital System Supply Identifier | 877634 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X280MM LT","code_information":[{"code":"Sx00-1501-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878973","type":"LOCAL"},{"code":"877635","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878973 = Hospital System Supply Identifier | 877635 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X360MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878977","type":"LOCAL"},{"code":"877639","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878977 = Hospital System Supply Identifier | 877639 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X300MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878974","type":"LOCAL"},{"code":"877636","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878974 = Hospital System Supply Identifier | 877636 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X320MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878975","type":"LOCAL"},{"code":"877637","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878975 = Hospital System Supply Identifier | 877637 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X340MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878976","type":"LOCAL"},{"code":"877638","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878976 = Hospital System Supply Identifier | 877638 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X380MM LT","code_information":[{"code":"Sx00-1501-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878978","type":"LOCAL"},{"code":"877640","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878978 = Hospital System Supply Identifier | 877640 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X420MM LT","code_information":[{"code":"Sx00-1501-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878980","type":"LOCAL"},{"code":"877642","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878980 = Hospital System Supply Identifier | 877642 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X400MM LT","code_information":[{"code":"Sx00-1501-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878979","type":"LOCAL"},{"code":"877641","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878979 = Hospital System Supply Identifier | 877641 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X280MM LT","code_information":[{"code":"Sx00-1501-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878981","type":"LOCAL"},{"code":"877643","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878981 = Hospital System Supply Identifier | 877643 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X300MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878982","type":"LOCAL"},{"code":"877644","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878982 = Hospital System Supply Identifier | 877644 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X320MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878983","type":"LOCAL"},{"code":"877645","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878983 = Hospital System Supply Identifier | 877645 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X340MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878984","type":"LOCAL"},{"code":"877646","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878984 = Hospital System Supply Identifier | 877646 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X360MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878985","type":"LOCAL"},{"code":"877647","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878985 = Hospital System Supply Identifier | 877647 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X380MM LT","code_information":[{"code":"Sx00-1501-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878986","type":"LOCAL"},{"code":"877648","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878986 = Hospital System Supply Identifier | 877648 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X400MM LT","code_information":[{"code":"Sx00-1501-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878987","type":"LOCAL"},{"code":"877649","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878987 = Hospital System Supply Identifier | 877649 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X420MM LT","code_information":[{"code":"Sx00-1501-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878988","type":"LOCAL"},{"code":"877650","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878988 = Hospital System Supply Identifier | 877650 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 5MM","code_information":[{"code":"Sx00-1501-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878990","type":"LOCAL"},{"code":"877652","type":"LOCAL"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":437.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878990 = Hospital System Supply Identifier | 877652 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 0MM","code_information":[{"code":"Sx00-1501-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878989","type":"LOCAL"},{"code":"877651","type":"LOCAL"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":437.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878989 = Hospital System Supply Identifier | 877651 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 10MM","code_information":[{"code":"Sx00-1501-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878991","type":"LOCAL"},{"code":"877653","type":"LOCAL"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":437.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878991 = Hospital System Supply Identifier | 877653 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 15MM","code_information":[{"code":"Sx00-1501-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878992","type":"LOCAL"},{"code":"877654","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878992 = Hospital System Supply Identifier | 877654 = Lawson ID"}]},{"description":"END CAP NAIL PIP CHILD 20MM","code_information":[{"code":"Sx00-1501-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878993","type":"LOCAL"},{"code":"877655","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878993 = Hospital System Supply Identifier | 877655 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175931","type":"LOCAL"},{"code":"1083649","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175931 = Hospital System Supply Identifier | 1083649 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175983","type":"LOCAL"},{"code":"1083709","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175983 = Hospital System Supply Identifier | 1083709 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176464","type":"LOCAL"},{"code":"1083692","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176464 = Hospital System Supply Identifier | 1083692 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176610","type":"LOCAL"},{"code":"1083705","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176610 = Hospital System Supply Identifier | 1083705 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1501-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176301","type":"LOCAL"},{"code":"1083573","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176301 = Hospital System Supply Identifier | 1083573 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X280MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878998","type":"LOCAL"},{"code":"877660","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878998 = Hospital System Supply Identifier | 877660 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X260MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878997","type":"LOCAL"},{"code":"877659","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878997 = Hospital System Supply Identifier | 877659 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X200MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878994","type":"LOCAL"},{"code":"877656","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878994 = Hospital System Supply Identifier | 877656 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X220MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878995","type":"LOCAL"},{"code":"877657","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878995 = Hospital System Supply Identifier | 877657 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X240MM RT","code_information":[{"code":"Sx00-1502-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878996","type":"LOCAL"},{"code":"877658","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878996 = Hospital System Supply Identifier | 877658 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X300MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"878999","type":"LOCAL"},{"code":"877661","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 878999 = Hospital System Supply Identifier | 877661 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X320MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879000","type":"LOCAL"},{"code":"877662","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879000 = Hospital System Supply Identifier | 877662 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X340MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879001","type":"LOCAL"},{"code":"877663","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879001 = Hospital System Supply Identifier | 877663 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X360MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879002","type":"LOCAL"},{"code":"877664","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879002 = Hospital System Supply Identifier | 877664 = Lawson ID"}]},{"description":"NAIL PIP CHILD 7X380MM RT","code_information":[{"code":"Sx00-1502-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879003","type":"LOCAL"},{"code":"877665","type":"LOCAL"}],"standard_charges":[{"gross_charge":11340.0,"discounted_cash":7938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879003 = Hospital System Supply Identifier | 877665 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X260MM RT","code_information":[{"code":"Sx00-1502-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879005","type":"LOCAL"},{"code":"877667","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879005 = Hospital System Supply Identifier | 877667 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X280MM RT","code_information":[{"code":"Sx00-1502-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879006","type":"LOCAL"},{"code":"877668","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879006 = Hospital System Supply Identifier | 877668 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X240MM RT","code_information":[{"code":"Sx00-1502-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879004","type":"LOCAL"},{"code":"877666","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879004 = Hospital System Supply Identifier | 877666 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X300MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879007","type":"LOCAL"},{"code":"877669","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879007 = Hospital System Supply Identifier | 877669 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X320MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879008","type":"LOCAL"},{"code":"877670","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879008 = Hospital System Supply Identifier | 877670 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X340MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879009","type":"LOCAL"},{"code":"877671","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879009 = Hospital System Supply Identifier | 877671 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X360MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879010","type":"LOCAL"},{"code":"877672","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879010 = Hospital System Supply Identifier | 877672 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X380MM RT","code_information":[{"code":"Sx00-1502-083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879011","type":"LOCAL"},{"code":"877673","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879011 = Hospital System Supply Identifier | 877673 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X400MM RT","code_information":[{"code":"Sx00-1502-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879012","type":"LOCAL"},{"code":"877674","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879012 = Hospital System Supply Identifier | 877674 = Lawson ID"}]},{"description":"NAIL PIP CHILD 8X420MM RT","code_information":[{"code":"Sx00-1502-084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879013","type":"LOCAL"},{"code":"877675","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879013 = Hospital System Supply Identifier | 877675 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X280MM RT","code_information":[{"code":"Sx00-1502-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879014","type":"LOCAL"},{"code":"877676","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879014 = Hospital System Supply Identifier | 877676 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X380MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879019","type":"LOCAL"},{"code":"877681","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879019 = Hospital System Supply Identifier | 877681 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X360MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879018","type":"LOCAL"},{"code":"877680","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879018 = Hospital System Supply Identifier | 877680 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X300MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879015","type":"LOCAL"},{"code":"877677","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879015 = Hospital System Supply Identifier | 877677 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X320MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879016","type":"LOCAL"},{"code":"877678","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879016 = Hospital System Supply Identifier | 877678 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X340MM RT","code_information":[{"code":"Sx00-1502-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879017","type":"LOCAL"},{"code":"877679","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879017 = Hospital System Supply Identifier | 877679 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X400MM RT","code_information":[{"code":"Sx00-1502-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879020","type":"LOCAL"},{"code":"877682","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879020 = Hospital System Supply Identifier | 877682 = Lawson ID"}]},{"description":"NAIL PIP CHILD 9X420MM RT","code_information":[{"code":"Sx00-1502-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879021","type":"LOCAL"},{"code":"877683","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879021 = Hospital System Supply Identifier | 877683 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X280MM LT","code_information":[{"code":"Sx00-1503-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879022","type":"LOCAL"},{"code":"877684","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879022 = Hospital System Supply Identifier | 877684 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X380MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879027","type":"LOCAL"},{"code":"877689","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879027 = Hospital System Supply Identifier | 877689 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X340MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879025","type":"LOCAL"},{"code":"877687","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879025 = Hospital System Supply Identifier | 877687 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X360MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879026","type":"LOCAL"},{"code":"877688","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879026 = Hospital System Supply Identifier | 877688 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X300MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879023","type":"LOCAL"},{"code":"877685","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879023 = Hospital System Supply Identifier | 877685 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X320MM LT","code_information":[{"code":"Sx00-1503-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879024","type":"LOCAL"},{"code":"877686","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879024 = Hospital System Supply Identifier | 877686 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176690","type":"LOCAL"},{"code":"1083571","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176690 = Hospital System Supply Identifier | 1083571 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176399","type":"LOCAL"},{"code":"1083596","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176399 = Hospital System Supply Identifier | 1083596 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176662","type":"LOCAL"},{"code":"1083657","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176662 = Hospital System Supply Identifier | 1083657 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X400MM LT","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879028","type":"LOCAL"},{"code":"877690","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879028 = Hospital System Supply Identifier | 877690 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X420MM LT","code_information":[{"code":"Sx00-1503-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879029","type":"LOCAL"},{"code":"877691","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879029 = Hospital System Supply Identifier | 877691 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X380MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879034","type":"LOCAL"},{"code":"877696","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879034 = Hospital System Supply Identifier | 877696 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X360MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879033","type":"LOCAL"},{"code":"877695","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879033 = Hospital System Supply Identifier | 877695 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X340MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879032","type":"LOCAL"},{"code":"877694","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879032 = Hospital System Supply Identifier | 877694 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X320MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879031","type":"LOCAL"},{"code":"877693","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879031 = Hospital System Supply Identifier | 877693 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X300MM LT","code_information":[{"code":"Sx00-1503-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879030","type":"LOCAL"},{"code":"877692","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879030 = Hospital System Supply Identifier | 877692 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176647","type":"LOCAL"},{"code":"1083647","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176647 = Hospital System Supply Identifier | 1083647 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175780","type":"LOCAL"},{"code":"1083680","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175780 = Hospital System Supply Identifier | 1083680 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176228","type":"LOCAL"},{"code":"1083713","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176228 = Hospital System Supply Identifier | 1083713 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X400MM LT","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879035","type":"LOCAL"},{"code":"877697","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879035 = Hospital System Supply Identifier | 877697 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X420MM LT","code_information":[{"code":"Sx00-1503-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879036","type":"LOCAL"},{"code":"877698","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879036 = Hospital System Supply Identifier | 877698 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X380MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879041","type":"LOCAL"},{"code":"877703","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879041 = Hospital System Supply Identifier | 877703 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X360MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879040","type":"LOCAL"},{"code":"877702","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879040 = Hospital System Supply Identifier | 877702 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X340MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879039","type":"LOCAL"},{"code":"877701","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879039 = Hospital System Supply Identifier | 877701 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X320MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879038","type":"LOCAL"},{"code":"877700","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879038 = Hospital System Supply Identifier | 877700 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X300MM LT","code_information":[{"code":"Sx00-1503-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879037","type":"LOCAL"},{"code":"877699","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879037 = Hospital System Supply Identifier | 877699 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176049","type":"LOCAL"},{"code":"1083577","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176049 = Hospital System Supply Identifier | 1083577 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176151","type":"LOCAL"},{"code":"1083611","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176151 = Hospital System Supply Identifier | 1083611 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175926","type":"LOCAL"},{"code":"1083662","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175926 = Hospital System Supply Identifier | 1083662 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X400MM LT","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879042","type":"LOCAL"},{"code":"877704","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879042 = Hospital System Supply Identifier | 877704 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X420MM LT","code_information":[{"code":"Sx00-1503-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879043","type":"LOCAL"},{"code":"877705","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879043 = Hospital System Supply Identifier | 877705 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X380MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879048","type":"LOCAL"},{"code":"877710","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879048 = Hospital System Supply Identifier | 877710 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X360MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879047","type":"LOCAL"},{"code":"877709","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879047 = Hospital System Supply Identifier | 877709 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X340MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879046","type":"LOCAL"},{"code":"877708","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879046 = Hospital System Supply Identifier | 877708 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X320MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879045","type":"LOCAL"},{"code":"877707","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879045 = Hospital System Supply Identifier | 877707 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X300MM LT","code_information":[{"code":"Sx00-1503-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879044","type":"LOCAL"},{"code":"877706","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879044 = Hospital System Supply Identifier | 877706 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176190","type":"LOCAL"},{"code":"1083552","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176190 = Hospital System Supply Identifier | 1083552 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176123","type":"LOCAL"},{"code":"1083726","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176123 = Hospital System Supply Identifier | 1083726 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176630","type":"LOCAL"},{"code":"1083751","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176630 = Hospital System Supply Identifier | 1083751 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X400MM LT","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879049","type":"LOCAL"},{"code":"877711","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879049 = Hospital System Supply Identifier | 877711 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X420MM LT","code_information":[{"code":"Sx00-1503-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879050","type":"LOCAL"},{"code":"877712","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879050 = Hospital System Supply Identifier | 877712 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 0MM","code_information":[{"code":"Sx00-1503-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879051","type":"LOCAL"},{"code":"877713","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879051 = Hospital System Supply Identifier | 877713 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 5MM","code_information":[{"code":"Sx00-1503-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879052","type":"LOCAL"},{"code":"877714","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879052 = Hospital System Supply Identifier | 877714 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 15MM","code_information":[{"code":"Sx00-1503-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879054","type":"LOCAL"},{"code":"877716","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879054 = Hospital System Supply Identifier | 877716 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 10MM","code_information":[{"code":"Sx00-1503-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879053","type":"LOCAL"},{"code":"877715","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879053 = Hospital System Supply Identifier | 877715 = Lawson ID"}]},{"description":"END CAP NAIL PIP ADOL 20MM","code_information":[{"code":"Sx00-1503-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879055","type":"LOCAL"},{"code":"877717","type":"LOCAL"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":577.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879055 = Hospital System Supply Identifier | 877717 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176144","type":"LOCAL"},{"code":"1083654","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176144 = Hospital System Supply Identifier | 1083654 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175778","type":"LOCAL"},{"code":"1083667","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175778 = Hospital System Supply Identifier | 1083667 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176398","type":"LOCAL"},{"code":"1083561","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176398 = Hospital System Supply Identifier | 1083561 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176548","type":"LOCAL"},{"code":"1083609","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176548 = Hospital System Supply Identifier | 1083609 = Lawson ID"}]},{"description":"IMPLANT-BONE ENDCAP INTRAMEDULLARY-NAIL RETAINING LATEX-FREE","code_information":[{"code":"Sx00-1503-302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176052","type":"LOCAL"},{"code":"1083677","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.5,"discounted_cash":797.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176052 = Hospital System Supply Identifier | 1083677 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X280MM RT","code_information":[{"code":"Sx00-1504-092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879056","type":"LOCAL"},{"code":"877718","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879056 = Hospital System Supply Identifier | 877718 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X380MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879061","type":"LOCAL"},{"code":"877723","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879061 = Hospital System Supply Identifier | 877723 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X360MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879060","type":"LOCAL"},{"code":"877722","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879060 = Hospital System Supply Identifier | 877722 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X340MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879059","type":"LOCAL"},{"code":"877721","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879059 = Hospital System Supply Identifier | 877721 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X320MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879058","type":"LOCAL"},{"code":"877720","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879058 = Hospital System Supply Identifier | 877720 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X300MM RT","code_information":[{"code":"Sx00-1504-093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879057","type":"LOCAL"},{"code":"877719","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879057 = Hospital System Supply Identifier | 877719 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175939","type":"LOCAL"},{"code":"1083557","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175939 = Hospital System Supply Identifier | 1083557 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175944","type":"LOCAL"},{"code":"1083574","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175944 = Hospital System Supply Identifier | 1083574 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175765","type":"LOCAL"},{"code":"1083734","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175765 = Hospital System Supply Identifier | 1083734 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X400MM RT","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879062","type":"LOCAL"},{"code":"877724","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879062 = Hospital System Supply Identifier | 877724 = Lawson ID"}]},{"description":"NAIL PIP ADOL 9X420MM RT","code_information":[{"code":"Sx00-1504-094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879063","type":"LOCAL"},{"code":"877725","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879063 = Hospital System Supply Identifier | 877725 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X380MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879068","type":"LOCAL"},{"code":"877730","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879068 = Hospital System Supply Identifier | 877730 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X360MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879067","type":"LOCAL"},{"code":"877729","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879067 = Hospital System Supply Identifier | 877729 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X340MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879066","type":"LOCAL"},{"code":"877728","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879066 = Hospital System Supply Identifier | 877728 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X320MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879065","type":"LOCAL"},{"code":"877727","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879065 = Hospital System Supply Identifier | 877727 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X300MM RT","code_information":[{"code":"Sx00-1504-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879064","type":"LOCAL"},{"code":"877726","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879064 = Hospital System Supply Identifier | 877726 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175805","type":"LOCAL"},{"code":"1083555","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175805 = Hospital System Supply Identifier | 1083555 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176376","type":"LOCAL"},{"code":"1083653","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176376 = Hospital System Supply Identifier | 1083653 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176145","type":"LOCAL"},{"code":"1083666","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176145 = Hospital System Supply Identifier | 1083666 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X400MM RT","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879069","type":"LOCAL"},{"code":"877731","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879069 = Hospital System Supply Identifier | 877731 = Lawson ID"}]},{"description":"NAIL PIP ADOL 10X420MM RT","code_information":[{"code":"Sx00-1504-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879070","type":"LOCAL"},{"code":"877732","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879070 = Hospital System Supply Identifier | 877732 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X380MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879075","type":"LOCAL"},{"code":"877737","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879075 = Hospital System Supply Identifier | 877737 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X340MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879073","type":"LOCAL"},{"code":"877735","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879073 = Hospital System Supply Identifier | 877735 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X360MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879074","type":"LOCAL"},{"code":"877736","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879074 = Hospital System Supply Identifier | 877736 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X300MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879071","type":"LOCAL"},{"code":"877733","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879071 = Hospital System Supply Identifier | 877733 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X320MM RT","code_information":[{"code":"Sx00-1504-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879072","type":"LOCAL"},{"code":"877734","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879072 = Hospital System Supply Identifier | 877734 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176173","type":"LOCAL"},{"code":"1083543","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176173 = Hospital System Supply Identifier | 1083543 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176397","type":"LOCAL"},{"code":"1083602","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176397 = Hospital System Supply Identifier | 1083602 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176365","type":"LOCAL"},{"code":"1083722","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176365 = Hospital System Supply Identifier | 1083722 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X400MM RT","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879076","type":"LOCAL"},{"code":"877738","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879076 = Hospital System Supply Identifier | 877738 = Lawson ID"}]},{"description":"NAIL PIP ADOL 11X420MM RT","code_information":[{"code":"Sx00-1504-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879077","type":"LOCAL"},{"code":"877739","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879077 = Hospital System Supply Identifier | 877739 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X360MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879081","type":"LOCAL"},{"code":"877743","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879081 = Hospital System Supply Identifier | 877743 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X380MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879082","type":"LOCAL"},{"code":"877744","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879082 = Hospital System Supply Identifier | 877744 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X340MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879080","type":"LOCAL"},{"code":"877742","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879080 = Hospital System Supply Identifier | 877742 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X320MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879079","type":"LOCAL"},{"code":"877741","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879079 = Hospital System Supply Identifier | 877741 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X300MM RT","code_information":[{"code":"Sx00-1504-123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879078","type":"LOCAL"},{"code":"877740","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879078 = Hospital System Supply Identifier | 877740 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176546","type":"LOCAL"},{"code":"1083570","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176546 = Hospital System Supply Identifier | 1083570 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176155","type":"LOCAL"},{"code":"1083679","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176155 = Hospital System Supply Identifier | 1083679 = Lawson ID"}]},{"description":"IMPLANT-BONE INTRAMEDULLARY-NAIL FEMORAL STAINLESS-STEEL","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176510","type":"LOCAL"},{"code":"1083750","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176510 = Hospital System Supply Identifier | 1083750 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X400MM RT","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879083","type":"LOCAL"},{"code":"877745","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879083 = Hospital System Supply Identifier | 877745 = Lawson ID"}]},{"description":"NAIL PIP ADOL 12X420MM RT","code_information":[{"code":"Sx00-1504-124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879084","type":"LOCAL"},{"code":"877746","type":"LOCAL"}],"standard_charges":[{"gross_charge":11154.0,"discounted_cash":7807.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879084 = Hospital System Supply Identifier | 877746 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X25MM","code_information":[{"code":"Sx00-1506-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879085","type":"LOCAL"},{"code":"877747","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879085 = Hospital System Supply Identifier | 877747 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X27.5MM","code_information":[{"code":"Sx00-1506-102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879086","type":"LOCAL"},{"code":"877748","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879086 = Hospital System Supply Identifier | 877748 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X37.5MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879090","type":"LOCAL"},{"code":"877752","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879090 = Hospital System Supply Identifier | 877752 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X35MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879089","type":"LOCAL"},{"code":"877751","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879089 = Hospital System Supply Identifier | 877751 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X32.5MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879088","type":"LOCAL"},{"code":"877750","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879088 = Hospital System Supply Identifier | 877750 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X30MM","code_information":[{"code":"Sx00-1506-103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879087","type":"LOCAL"},{"code":"877749","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879087 = Hospital System Supply Identifier | 877749 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X40MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879091","type":"LOCAL"},{"code":"877753","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879091 = Hospital System Supply Identifier | 877753 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X42.5MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879092","type":"LOCAL"},{"code":"877754","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879092 = Hospital System Supply Identifier | 877754 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X45MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879093","type":"LOCAL"},{"code":"877755","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879093 = Hospital System Supply Identifier | 877755 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X47.5MM","code_information":[{"code":"Sx00-1506-104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879094","type":"LOCAL"},{"code":"877756","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879094 = Hospital System Supply Identifier | 877756 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X55MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879097","type":"LOCAL"},{"code":"877759","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879097 = Hospital System Supply Identifier | 877759 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X57.5MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879098","type":"LOCAL"},{"code":"877760","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879098 = Hospital System Supply Identifier | 877760 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X50MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879095","type":"LOCAL"},{"code":"877757","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879095 = Hospital System Supply Identifier | 877757 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X52.5MM","code_information":[{"code":"Sx00-1506-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879096","type":"LOCAL"},{"code":"877758","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879096 = Hospital System Supply Identifier | 877758 = Lawson ID"}]},{"description":"PEG UNICORT 3.8X60MM","code_information":[{"code":"Sx00-1506-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879099","type":"LOCAL"},{"code":"877761","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879099 = Hospital System Supply Identifier | 877761 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176174","type":"LOCAL"},{"code":"1083546","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176174 = Hospital System Supply Identifier | 1083546 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175815","type":"LOCAL"},{"code":"1083583","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175815 = Hospital System Supply Identifier | 1083583 = Lawson ID"}]},{"description":"SCREW F/T 4.5X27.5MM","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879101","type":"LOCAL"},{"code":"877763","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879101 = Hospital System Supply Identifier | 877763 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175923","type":"LOCAL"},{"code":"1083562","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175923 = Hospital System Supply Identifier | 1083562 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176366","type":"LOCAL"},{"code":"1083737","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176366 = Hospital System Supply Identifier | 1083737 = Lawson ID"}]},{"description":"SCREW F/T 4.5X25MM","code_information":[{"code":"Sx00-1506-202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879100","type":"LOCAL"},{"code":"877762","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879100 = Hospital System Supply Identifier | 877762 = Lawson ID"}]},{"description":"SCREW F/T 4.5X35MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879104","type":"LOCAL"},{"code":"877766","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879104 = Hospital System Supply Identifier | 877766 = Lawson ID"}]},{"description":"SCREW F/T 4.5X37.5MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879105","type":"LOCAL"},{"code":"877767","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879105 = Hospital System Supply Identifier | 877767 = Lawson ID"}]},{"description":"SCREW F/T 4.5X30MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879102","type":"LOCAL"},{"code":"877764","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879102 = Hospital System Supply Identifier | 877764 = Lawson ID"}]},{"description":"SCREW F/T 4.5X32.5MM","code_information":[{"code":"Sx00-1506-203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879103","type":"LOCAL"},{"code":"877765","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879103 = Hospital System Supply Identifier | 877765 = Lawson ID"}]},{"description":"SCREW F/T 4.5X40MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879106","type":"LOCAL"},{"code":"877768","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879106 = Hospital System Supply Identifier | 877768 = Lawson ID"}]},{"description":"SCREW F/T 4.5X42.5MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879107","type":"LOCAL"},{"code":"877769","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879107 = Hospital System Supply Identifier | 877769 = Lawson ID"}]},{"description":"SCREW F/T 4.5X45MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879108","type":"LOCAL"},{"code":"877770","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879108 = Hospital System Supply Identifier | 877770 = Lawson ID"}]},{"description":"SCREW F/T 4.5X47.5MM","code_information":[{"code":"Sx00-1506-204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879109","type":"LOCAL"},{"code":"877771","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879109 = Hospital System Supply Identifier | 877771 = Lawson ID"}]},{"description":"SCREW F/T 4.5X50MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879110","type":"LOCAL"},{"code":"877772","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879110 = Hospital System Supply Identifier | 877772 = Lawson ID"}]},{"description":"SCREW F/T 4.5X52.5MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879111","type":"LOCAL"},{"code":"877773","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879111 = Hospital System Supply Identifier | 877773 = Lawson ID"}]},{"description":"SCREW F/T 4.5X55MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879112","type":"LOCAL"},{"code":"877774","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879112 = Hospital System Supply Identifier | 877774 = Lawson ID"}]},{"description":"SCREW F/T 4.5X57.5MM","code_information":[{"code":"Sx00-1506-205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879113","type":"LOCAL"},{"code":"877775","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879113 = Hospital System Supply Identifier | 877775 = Lawson ID"}]},{"description":"SCREW F/T 4.5X67.5MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879117","type":"LOCAL"},{"code":"877779","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879117 = Hospital System Supply Identifier | 877779 = Lawson ID"}]},{"description":"SCREW F/T 4.5X65MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879116","type":"LOCAL"},{"code":"877778","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879116 = Hospital System Supply Identifier | 877778 = Lawson ID"}]},{"description":"SCREW F/T 4.5X60MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879114","type":"LOCAL"},{"code":"877776","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879114 = Hospital System Supply Identifier | 877776 = Lawson ID"}]},{"description":"SCREW F/T 4.5X62.5MM","code_information":[{"code":"Sx00-1506-206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879115","type":"LOCAL"},{"code":"877777","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879115 = Hospital System Supply Identifier | 877777 = Lawson ID"}]},{"description":"SCREW F/T 4.5X70MM","code_information":[{"code":"Sx00-1506-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879118","type":"LOCAL"},{"code":"877780","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879118 = Hospital System Supply Identifier | 877780 = Lawson ID"}]},{"description":"SCREW F/T 4.5X75MM","code_information":[{"code":"Sx00-1506-207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879119","type":"LOCAL"},{"code":"877781","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879119 = Hospital System Supply Identifier | 877781 = Lawson ID"}]},{"description":"SCREW F/T 4.5X80MM","code_information":[{"code":"Sx00-1506-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879120","type":"LOCAL"},{"code":"877782","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879120 = Hospital System Supply Identifier | 877782 = Lawson ID"}]},{"description":"SCREW F/T 4.5X85MM","code_information":[{"code":"Sx00-1506-208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879121","type":"LOCAL"},{"code":"877783","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879121 = Hospital System Supply Identifier | 877783 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175930","type":"LOCAL"},{"code":"1083581","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175930 = Hospital System Supply Identifier | 1083581 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176520","type":"LOCAL"},{"code":"1083696","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176520 = Hospital System Supply Identifier | 1083696 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176414","type":"LOCAL"},{"code":"1083582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176414 = Hospital System Supply Identifier | 1083582 = Lawson ID"}]},{"description":"SCREW P/T 4.5X47.5MM","code_information":[{"code":"Sx00-1506-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879123","type":"LOCAL"},{"code":"877785","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879123 = Hospital System Supply Identifier | 877785 = Lawson ID"}]},{"description":"SCREW P/T 4.5X45MM","code_information":[{"code":"Sx00-1506-304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879122","type":"LOCAL"},{"code":"877784","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879122 = Hospital System Supply Identifier | 877784 = Lawson ID"}]},{"description":"SCREW P/T 4.5X50MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879124","type":"LOCAL"},{"code":"877786","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879124 = Hospital System Supply Identifier | 877786 = Lawson ID"}]},{"description":"SCREW P/T 4.5X52.5MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879125","type":"LOCAL"},{"code":"877787","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879125 = Hospital System Supply Identifier | 877787 = Lawson ID"}]},{"description":"SCREW P/T 4.5X55MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879126","type":"LOCAL"},{"code":"877788","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879126 = Hospital System Supply Identifier | 877788 = Lawson ID"}]},{"description":"SCREW P/T 4.5X57.5MM","code_information":[{"code":"Sx00-1506-305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879127","type":"LOCAL"},{"code":"877789","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879127 = Hospital System Supply Identifier | 877789 = Lawson ID"}]},{"description":"SCREW P/T 4.5X60MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879128","type":"LOCAL"},{"code":"877790","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879128 = Hospital System Supply Identifier | 877790 = Lawson ID"}]},{"description":"SCREW P/T 4.5X62.5MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879129","type":"LOCAL"},{"code":"877791","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879129 = Hospital System Supply Identifier | 877791 = Lawson ID"}]},{"description":"SCREW P/T 4.5X65MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879130","type":"LOCAL"},{"code":"877792","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879130 = Hospital System Supply Identifier | 877792 = Lawson ID"}]},{"description":"SCREW P/T 4.5X67.5MM","code_information":[{"code":"Sx00-1506-306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879131","type":"LOCAL"},{"code":"877793","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879131 = Hospital System Supply Identifier | 877793 = Lawson ID"}]},{"description":"SCREW P/T 4.5X75MM","code_information":[{"code":"Sx00-1506-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879133","type":"LOCAL"},{"code":"877795","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879133 = Hospital System Supply Identifier | 877795 = Lawson ID"}]},{"description":"SCREW P/T 4.5X70MM","code_information":[{"code":"Sx00-1506-307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879132","type":"LOCAL"},{"code":"877794","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879132 = Hospital System Supply Identifier | 877794 = Lawson ID"}]},{"description":"SCREW P/T 4.5X80MM","code_information":[{"code":"Sx00-1506-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879134","type":"LOCAL"},{"code":"877796","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879134 = Hospital System Supply Identifier | 877796 = Lawson ID"}]},{"description":"SCREW P/T 4.5X85MM","code_information":[{"code":"Sx00-1506-308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879135","type":"LOCAL"},{"code":"877797","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879135 = Hospital System Supply Identifier | 877797 = Lawson ID"}]},{"description":"SCREW P/T 4.5X90MM","code_information":[{"code":"Sx00-1506-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879137","type":"LOCAL"},{"code":"877798","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879137 = Hospital System Supply Identifier | 877798 = Lawson ID"}]},{"description":"SCREW P/T 4.5X95MM","code_information":[{"code":"Sx00-1506-309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879138","type":"LOCAL"},{"code":"877799","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879138 = Hospital System Supply Identifier | 877799 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176654","type":"LOCAL"},{"code":"1083731","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176654 = Hospital System Supply Identifier | 1083731 = Lawson ID"}]},{"description":"SCREW P/T 4.5X100MM","code_information":[{"code":"Sx00-1506-310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879139","type":"LOCAL"},{"code":"877800","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879139 = Hospital System Supply Identifier | 877800 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176184","type":"LOCAL"},{"code":"1083595","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176184 = Hospital System Supply Identifier | 1083595 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175911","type":"LOCAL"},{"code":"1083715","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175911 = Hospital System Supply Identifier | 1083715 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL PARTIAL-THREAD","code_information":[{"code":"Sx00-1506-312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176413","type":"LOCAL"},{"code":"1083540","type":"LOCAL"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":918.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176413 = Hospital System Supply Identifier | 1083540 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176643","type":"LOCAL"},{"code":"1083711","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176643 = Hospital System Supply Identifier | 1083711 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176400","type":"LOCAL"},{"code":"1083610","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176400 = Hospital System Supply Identifier | 1083610 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED FEMORAL PNP FEMUR 0015064023 5.0X22.5MM","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175921","type":"LOCAL"},{"code":"1082572","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175921 = Hospital System Supply Identifier | 1082572 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176146","type":"LOCAL"},{"code":"1083718","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176146 = Hospital System Supply Identifier | 1083718 = Lawson ID"}]},{"description":"SCREW F/T 5.0X25MM","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879140","type":"LOCAL"},{"code":"877801","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879140 = Hospital System Supply Identifier | 877801 = Lawson ID"}]},{"description":"SCREW F/T 5.0X27.5MM","code_information":[{"code":"Sx00-1506-402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879141","type":"LOCAL"},{"code":"877802","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879141 = Hospital System Supply Identifier | 877802 = Lawson ID"}]},{"description":"SCREW F/T 5.0X30MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879142","type":"LOCAL"},{"code":"877803","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879142 = Hospital System Supply Identifier | 877803 = Lawson ID"}]},{"description":"SCREW F/T 5.0X32.5MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879143","type":"LOCAL"},{"code":"877804","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879143 = Hospital System Supply Identifier | 877804 = Lawson ID"}]},{"description":"SCREW F/T 5.0X35MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879145","type":"LOCAL"},{"code":"877805","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879145 = Hospital System Supply Identifier | 877805 = Lawson ID"}]},{"description":"SCREW F/T 5.0X37.5MM","code_information":[{"code":"Sx00-1506-403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879146","type":"LOCAL"},{"code":"877806","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879146 = Hospital System Supply Identifier | 877806 = Lawson ID"}]},{"description":"SCREW F/T 5.0X47.5MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879150","type":"LOCAL"},{"code":"877810","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879150 = Hospital System Supply Identifier | 877810 = Lawson ID"}]},{"description":"SCREW F/T 5.0X45MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879149","type":"LOCAL"},{"code":"877809","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879149 = Hospital System Supply Identifier | 877809 = Lawson ID"}]},{"description":"SCREW F/T 5.0X40MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879147","type":"LOCAL"},{"code":"877807","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879147 = Hospital System Supply Identifier | 877807 = Lawson ID"}]},{"description":"SCREW F/T 5.0X42.5MM","code_information":[{"code":"Sx00-1506-404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879148","type":"LOCAL"},{"code":"877808","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879148 = Hospital System Supply Identifier | 877808 = Lawson ID"}]},{"description":"SCREW F/T 5.0X50MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879151","type":"LOCAL"},{"code":"877811","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879151 = Hospital System Supply Identifier | 877811 = Lawson ID"}]},{"description":"SCREW F/T 5.0X52.5MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879152","type":"LOCAL"},{"code":"877812","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879152 = Hospital System Supply Identifier | 877812 = Lawson ID"}]},{"description":"SCREW F/T 5.0X55MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879153","type":"LOCAL"},{"code":"877813","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879153 = Hospital System Supply Identifier | 877813 = Lawson ID"}]},{"description":"SCREW F/T 5.0X57.5MM","code_information":[{"code":"Sx00-1506-405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879154","type":"LOCAL"},{"code":"877814","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879154 = Hospital System Supply Identifier | 877814 = Lawson ID"}]},{"description":"SCREW F/T 5.0X67.5MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879158","type":"LOCAL"},{"code":"877818","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879158 = Hospital System Supply Identifier | 877818 = Lawson ID"}]},{"description":"SCREW F/T 5.0X65MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879157","type":"LOCAL"},{"code":"877817","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879157 = Hospital System Supply Identifier | 877817 = Lawson ID"}]},{"description":"SCREW F/T 5.0X62.5MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879156","type":"LOCAL"},{"code":"877816","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879156 = Hospital System Supply Identifier | 877816 = Lawson ID"}]},{"description":"SCREW F/T 5.0X60MM","code_information":[{"code":"Sx00-1506-406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879155","type":"LOCAL"},{"code":"877815","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879155 = Hospital System Supply Identifier | 877815 = Lawson ID"}]},{"description":"SCREW F/T 5.0X70MM","code_information":[{"code":"Sx00-1506-407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879159","type":"LOCAL"},{"code":"877819","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879159 = Hospital System Supply Identifier | 877819 = Lawson ID"}]},{"description":"SCREW F/T 5.0X75MM","code_information":[{"code":"Sx00-1506-407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879160","type":"LOCAL"},{"code":"877820","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879160 = Hospital System Supply Identifier | 877820 = Lawson ID"}]},{"description":"SCREW F/T 5.0X80MM","code_information":[{"code":"Sx00-1506-408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879161","type":"LOCAL"},{"code":"877821","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879161 = Hospital System Supply Identifier | 877821 = Lawson ID"}]},{"description":"SCREW F/T 5.0X85MM","code_information":[{"code":"Sx00-1506-408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879162","type":"LOCAL"},{"code":"877822","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879162 = Hospital System Supply Identifier | 877822 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176553","type":"LOCAL"},{"code":"1083584","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176553 = Hospital System Supply Identifier | 1083584 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175904","type":"LOCAL"},{"code":"1083738","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175904 = Hospital System Supply Identifier | 1083738 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176005","type":"LOCAL"},{"code":"1083720","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176005 = Hospital System Supply Identifier | 1083720 = Lawson ID"}]},{"description":"SCREW P/T 5.0X45MM","code_information":[{"code":"Sx00-1506-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879163","type":"LOCAL"},{"code":"877823","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879163 = Hospital System Supply Identifier | 877823 = Lawson ID"}]},{"description":"SCREW P/T 5.0X47.5MM","code_information":[{"code":"Sx00-1506-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879164","type":"LOCAL"},{"code":"877824","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879164 = Hospital System Supply Identifier | 877824 = Lawson ID"}]},{"description":"SCREW P/T 5.0X57.5MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879168","type":"LOCAL"},{"code":"877828","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879168 = Hospital System Supply Identifier | 877828 = Lawson ID"}]},{"description":"SCREW P/T 5.0X55MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879167","type":"LOCAL"},{"code":"877827","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879167 = Hospital System Supply Identifier | 877827 = Lawson ID"}]},{"description":"SCREW P/T 5.0X50MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879165","type":"LOCAL"},{"code":"877825","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879165 = Hospital System Supply Identifier | 877825 = Lawson ID"}]},{"description":"SCREW P/T 5.0X52.5MM","code_information":[{"code":"Sx00-1506-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879166","type":"LOCAL"},{"code":"877826","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879166 = Hospital System Supply Identifier | 877826 = Lawson ID"}]},{"description":"SCREW P/T 5.0X60MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879169","type":"LOCAL"},{"code":"877829","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879169 = Hospital System Supply Identifier | 877829 = Lawson ID"}]},{"description":"SCREW P/T 5.0X62.5MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879170","type":"LOCAL"},{"code":"877830","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879170 = Hospital System Supply Identifier | 877830 = Lawson ID"}]},{"description":"SCREW P/T 5.0X65MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879171","type":"LOCAL"},{"code":"877831","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879171 = Hospital System Supply Identifier | 877831 = Lawson ID"}]},{"description":"SCREW P/T 5.0X67.5MM","code_information":[{"code":"Sx00-1506-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879172","type":"LOCAL"},{"code":"877832","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879172 = Hospital System Supply Identifier | 877832 = Lawson ID"}]},{"description":"SCREW P/T 5.0X75MM","code_information":[{"code":"Sx00-1506-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879174","type":"LOCAL"},{"code":"877834","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879174 = Hospital System Supply Identifier | 877834 = Lawson ID"}]},{"description":"SCREW P/T 5.0X70MM","code_information":[{"code":"Sx00-1506-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879173","type":"LOCAL"},{"code":"877833","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879173 = Hospital System Supply Identifier | 877833 = Lawson ID"}]},{"description":"SCREW P/T 5.0X85MM","code_information":[{"code":"Sx00-1506-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879176","type":"LOCAL"},{"code":"877836","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879176 = Hospital System Supply Identifier | 877836 = Lawson ID"}]},{"description":"SCREW P/T 5.0X80MM","code_information":[{"code":"Sx00-1506-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879175","type":"LOCAL"},{"code":"877835","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879175 = Hospital System Supply Identifier | 877835 = Lawson ID"}]},{"description":"SCREW P/T 5.0X90MM","code_information":[{"code":"Sx00-1506-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879177","type":"LOCAL"},{"code":"877837","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879177 = Hospital System Supply Identifier | 877837 = Lawson ID"}]},{"description":"SCREW P/T 5.0X95MM","code_information":[{"code":"Sx00-1506-509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879178","type":"LOCAL"},{"code":"877838","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879178 = Hospital System Supply Identifier | 877838 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176182","type":"LOCAL"},{"code":"1083665","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176182 = Hospital System Supply Identifier | 1083665 = Lawson ID"}]},{"description":"SCREW P/T 5.0X100MM","code_information":[{"code":"Sx00-1506-510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"879179","type":"LOCAL"},{"code":"877839","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 879179 = Hospital System Supply Identifier | 877839 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176277","type":"LOCAL"},{"code":"1083622","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176277 = Hospital System Supply Identifier | 1083622 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176498","type":"LOCAL"},{"code":"1083725","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176498 = Hospital System Supply Identifier | 1083725 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175813","type":"LOCAL"},{"code":"1083687","type":"LOCAL"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":1143.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175813 = Hospital System Supply Identifier | 1083687 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175788","type":"LOCAL"},{"code":"1083633","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175788 = Hospital System Supply Identifier | 1083633 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175791","type":"LOCAL"},{"code":"1083695","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175791 = Hospital System Supply Identifier | 1083695 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176663","type":"LOCAL"},{"code":"1083681","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176663 = Hospital System Supply Identifier | 1083681 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176286","type":"LOCAL"},{"code":"1083671","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176286 = Hospital System Supply Identifier | 1083671 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176176","type":"LOCAL"},{"code":"1083626","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176176 = Hospital System Supply Identifier | 1083626 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176269","type":"LOCAL"},{"code":"1083632","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176269 = Hospital System Supply Identifier | 1083632 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176683","type":"LOCAL"},{"code":"1083551","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176683 = Hospital System Supply Identifier | 1083551 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176417","type":"LOCAL"},{"code":"1083590","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176417 = Hospital System Supply Identifier | 1083590 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176268","type":"LOCAL"},{"code":"1083698","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176268 = Hospital System Supply Identifier | 1083698 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176026","type":"LOCAL"},{"code":"1083703","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176026 = Hospital System Supply Identifier | 1083703 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176183","type":"LOCAL"},{"code":"1083672","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176183 = Hospital System Supply Identifier | 1083672 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176186","type":"LOCAL"},{"code":"1083614","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176186 = Hospital System Supply Identifier | 1083614 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176545","type":"LOCAL"},{"code":"1083568","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176545 = Hospital System Supply Identifier | 1083568 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175806","type":"LOCAL"},{"code":"1083605","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175806 = Hospital System Supply Identifier | 1083605 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176177","type":"LOCAL"},{"code":"1083542","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176177 = Hospital System Supply Identifier | 1083542 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176549","type":"LOCAL"},{"code":"1083618","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176549 = Hospital System Supply Identifier | 1083618 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176401","type":"LOCAL"},{"code":"1083623","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176401 = Hospital System Supply Identifier | 1083623 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176262","type":"LOCAL"},{"code":"1083697","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176262 = Hospital System Supply Identifier | 1083697 = Lawson ID"}]},{"description":"SCREW-BONE LOCKING CANNULATED STAINLESS-STEEL FEMORAL","code_information":[{"code":"Sx00-1506-606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176143","type":"LOCAL"},{"code":"1083651","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176143 = Hospital System Supply Identifier | 1083651 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107240 TITANIUM 7X240MM","code_information":[{"code":"Sx00-1510-724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175799","type":"LOCAL"},{"code":"1082473","type":"LOCAL"}],"standard_charges":[{"gross_charge":11282.4,"discounted_cash":7897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175799 = Hospital System Supply Identifier | 1082473 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107255 TITANIUM 7X255MM","code_information":[{"code":"Sx00-1510-725","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176293","type":"LOCAL"},{"code":"1082526","type":"LOCAL"}],"standard_charges":[{"gross_charge":11282.4,"discounted_cash":7897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176293 = Hospital System Supply Identifier | 1082526 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107270 TITANIUM 7X270MM","code_information":[{"code":"Sx00-1510-727","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176636","type":"LOCAL"},{"code":"1082546","type":"LOCAL"}],"standard_charges":[{"gross_charge":11282.4,"discounted_cash":7897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176636 = Hospital System Supply Identifier | 1082546 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107285 TITANIUM 7X285MM","code_information":[{"code":"Sx00-1510-728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176154","type":"LOCAL"},{"code":"1082429","type":"LOCAL"}],"standard_charges":[{"gross_charge":11282.4,"discounted_cash":7897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176154 = Hospital System Supply Identifier | 1082429 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107300 TITANIUM 7X300MM","code_information":[{"code":"Sx00-1510-730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176131","type":"LOCAL"},{"code":"1082511","type":"LOCAL"}],"standard_charges":[{"gross_charge":11282.4,"discounted_cash":7897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176131 = Hospital System Supply Identifier | 1082511 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107315 TITANIUM 7X315MM","code_information":[{"code":"Sx00-1510-731","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176168","type":"LOCAL"},{"code":"1082580","type":"LOCAL"}],"standard_charges":[{"gross_charge":11282.4,"discounted_cash":7897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176168 = Hospital System Supply Identifier | 1082580 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107330 TITANIUM 7X330MM","code_information":[{"code":"Sx00-1510-733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176478","type":"LOCAL"},{"code":"1082569","type":"LOCAL"}],"standard_charges":[{"gross_charge":11282.4,"discounted_cash":7897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176478 = Hospital System Supply Identifier | 1082569 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107345 TITANIUM 7X345MM","code_information":[{"code":"Sx00-1510-734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175980","type":"LOCAL"},{"code":"1082439","type":"LOCAL"}],"standard_charges":[{"gross_charge":11282.4,"discounted_cash":7897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175980 = Hospital System Supply Identifier | 1082439 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107360 TITANIUM 7X360MM","code_information":[{"code":"Sx00-1510-736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176040","type":"LOCAL"},{"code":"1082475","type":"LOCAL"}],"standard_charges":[{"gross_charge":11282.4,"discounted_cash":7897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176040 = Hospital System Supply Identifier | 1082475 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107375 TITANIUM 7X375MM","code_information":[{"code":"Sx00-1510-737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176676","type":"LOCAL"},{"code":"1082549","type":"LOCAL"}],"standard_charges":[{"gross_charge":11282.4,"discounted_cash":7897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176676 = Hospital System Supply Identifier | 1082549 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015107390 TITANIUM 7X390MM","code_information":[{"code":"Sx00-1510-739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176257","type":"LOCAL"},{"code":"1082568","type":"LOCAL"}],"standard_charges":[{"gross_charge":11282.4,"discounted_cash":7897.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176257 = Hospital System Supply Identifier | 1082568 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108240 TITANIUM 8X240MM","code_information":[{"code":"Sx00-1510-824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175920","type":"LOCAL"},{"code":"1082451","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175920 = Hospital System Supply Identifier | 1082451 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108255 TITANIUM 8X255MM","code_information":[{"code":"Sx00-1510-825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176646","type":"LOCAL"},{"code":"1082593","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176646 = Hospital System Supply Identifier | 1082593 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108270 TITANIUM 8X270MM","code_information":[{"code":"Sx00-1510-827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175794","type":"LOCAL"},{"code":"1082490","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175794 = Hospital System Supply Identifier | 1082490 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108285 TITANIUM 8X285MM","code_information":[{"code":"Sx00-1510-828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175938","type":"LOCAL"},{"code":"1082436","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175938 = Hospital System Supply Identifier | 1082436 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108300 TITANIUM 8X300MM","code_information":[{"code":"Sx00-1510-830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176251","type":"LOCAL"},{"code":"1082563","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176251 = Hospital System Supply Identifier | 1082563 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108315 TITANIUM 8X315MM","code_information":[{"code":"Sx00-1510-831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176285","type":"LOCAL"},{"code":"1082427","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176285 = Hospital System Supply Identifier | 1082427 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108330 TITANIUM 8X330MM","code_information":[{"code":"Sx00-1510-833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176501","type":"LOCAL"},{"code":"1082591","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176501 = Hospital System Supply Identifier | 1082591 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108345 TITANIUM 8X345MM","code_information":[{"code":"Sx00-1510-834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176030","type":"LOCAL"},{"code":"1082437","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176030 = Hospital System Supply Identifier | 1082437 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108360 TITANIUM 8X360MM","code_information":[{"code":"Sx00-1510-836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176621","type":"LOCAL"},{"code":"1082542","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176621 = Hospital System Supply Identifier | 1082542 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108375 TITANIUM 8X375MM","code_information":[{"code":"Sx00-1510-837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176118","type":"LOCAL"},{"code":"1082586","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176118 = Hospital System Supply Identifier | 1082586 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108390 TITANIUM 8X390MM","code_information":[{"code":"Sx00-1510-839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176460","type":"LOCAL"},{"code":"1082525","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176460 = Hospital System Supply Identifier | 1082525 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108405 TITANIUM 8X405MM","code_information":[{"code":"Sx00-1510-840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176166","type":"LOCAL"},{"code":"1082470","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176166 = Hospital System Supply Identifier | 1082470 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015108420 TITANIUM 8X420MM","code_information":[{"code":"Sx00-1510-842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175901","type":"LOCAL"},{"code":"1082518","type":"LOCAL"}],"standard_charges":[{"gross_charge":11538.82,"discounted_cash":8077.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175901 = Hospital System Supply Identifier | 1082518 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109240 TITANIUM 9X240MM","code_information":[{"code":"Sx00-1510-924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176336","type":"LOCAL"},{"code":"1082484","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176336 = Hospital System Supply Identifier | 1082484 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109255 TITANIUM 9X255MM","code_information":[{"code":"Sx00-1510-925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175937","type":"LOCAL"},{"code":"1082499","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175937 = Hospital System Supply Identifier | 1082499 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109270 TITANIUM 9X270MM","code_information":[{"code":"Sx00-1510-927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176153","type":"LOCAL"},{"code":"1082433","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176153 = Hospital System Supply Identifier | 1082433 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109285 TITANIUM 9X285MM","code_information":[{"code":"Sx00-1510-928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176132","type":"LOCAL"},{"code":"1082500","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176132 = Hospital System Supply Identifier | 1082500 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109300 TITANIUM 9X300MM","code_information":[{"code":"Sx00-1510-930","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175816","type":"LOCAL"},{"code":"1082541","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175816 = Hospital System Supply Identifier | 1082541 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109315 TITANIUM 9X315MM","code_information":[{"code":"Sx00-1510-931","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176256","type":"LOCAL"},{"code":"1082522","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176256 = Hospital System Supply Identifier | 1082522 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109330 TITANIUM 9X330MM","code_information":[{"code":"Sx00-1510-933","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176560","type":"LOCAL"},{"code":"1082537","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176560 = Hospital System Supply Identifier | 1082537 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109345 TITANIUM 9X345MM","code_information":[{"code":"Sx00-1510-934","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175916","type":"LOCAL"},{"code":"1082506","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175916 = Hospital System Supply Identifier | 1082506 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109360 TITANIUM 9X360MM","code_information":[{"code":"Sx00-1510-936","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175903","type":"LOCAL"},{"code":"1082551","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175903 = Hospital System Supply Identifier | 1082551 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109375 TITANIUM 9X375MM","code_information":[{"code":"Sx00-1510-937","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176271","type":"LOCAL"},{"code":"1082527","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176271 = Hospital System Supply Identifier | 1082527 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109390 TITANIUM 9X390MM","code_information":[{"code":"Sx00-1510-939","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175917","type":"LOCAL"},{"code":"1082466","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175917 = Hospital System Supply Identifier | 1082466 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109405 TITANIUM 9X405MM","code_information":[{"code":"Sx00-1510-940","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176161","type":"LOCAL"},{"code":"1082493","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176161 = Hospital System Supply Identifier | 1082493 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015109420 TITANIUM 9X420MM","code_information":[{"code":"Sx00-1510-942","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175915","type":"LOCAL"},{"code":"1082447","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175915 = Hospital System Supply Identifier | 1082447 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110270 TITANIUM 10X270MM","code_information":[{"code":"Sx00-1511-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176600","type":"LOCAL"},{"code":"1082440","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176600 = Hospital System Supply Identifier | 1082440 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110285 TITANIUM 10X285MM","code_information":[{"code":"Sx00-1511-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176194","type":"LOCAL"},{"code":"1082479","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176194 = Hospital System Supply Identifier | 1082479 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110300 TITANIUM 10X300MM","code_information":[{"code":"Sx00-1511-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176404","type":"LOCAL"},{"code":"1082552","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176404 = Hospital System Supply Identifier | 1082552 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110315 TITANIUM 10X315MM","code_information":[{"code":"Sx00-1511-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176536","type":"LOCAL"},{"code":"1082471","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176536 = Hospital System Supply Identifier | 1082471 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110330 TITANIUM 10X330MM","code_information":[{"code":"Sx00-1511-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176042","type":"LOCAL"},{"code":"1082458","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176042 = Hospital System Supply Identifier | 1082458 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110345 TITANIUM 10X345MM","code_information":[{"code":"Sx00-1511-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175783","type":"LOCAL"},{"code":"1082516","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175783 = Hospital System Supply Identifier | 1082516 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110360 TITANIUM 10X360MM","code_information":[{"code":"Sx00-1511-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176603","type":"LOCAL"},{"code":"1082528","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176603 = Hospital System Supply Identifier | 1082528 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110375 TITANIUM 10X375MM","code_information":[{"code":"Sx00-1511-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175746","type":"LOCAL"},{"code":"1082469","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175746 = Hospital System Supply Identifier | 1082469 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110390 TITANIUM 10X390MM","code_information":[{"code":"Sx00-1511-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176653","type":"LOCAL"},{"code":"1082598","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176653 = Hospital System Supply Identifier | 1082598 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110405 TITANIUM 10X405MM","code_information":[{"code":"Sx00-1511-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176098","type":"LOCAL"},{"code":"1082524","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176098 = Hospital System Supply Identifier | 1082524 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015110420 TITANIUM 10X420MM","code_information":[{"code":"Sx00-1511-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176385","type":"LOCAL"},{"code":"1082489","type":"LOCAL"}],"standard_charges":[{"gross_charge":11807.15,"discounted_cash":8265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176385 = Hospital System Supply Identifier | 1082489 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111270 TITANIUM 11X270MM","code_information":[{"code":"Sx00-1511-127","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176226","type":"LOCAL"},{"code":"1082446","type":"LOCAL"}],"standard_charges":[{"gross_charge":12088.27,"discounted_cash":8461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176226 = Hospital System Supply Identifier | 1082446 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111285 TITANIUM 11X285MM","code_information":[{"code":"Sx00-1511-128","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176458","type":"LOCAL"},{"code":"1082498","type":"LOCAL"}],"standard_charges":[{"gross_charge":12088.27,"discounted_cash":8461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176458 = Hospital System Supply Identifier | 1082498 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111300 TITANIUM 11X300MM","code_information":[{"code":"Sx00-1511-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176009","type":"LOCAL"},{"code":"1082503","type":"LOCAL"}],"standard_charges":[{"gross_charge":12088.27,"discounted_cash":8461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176009 = Hospital System Supply Identifier | 1082503 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111315 TITANIUM 11X315MM","code_information":[{"code":"Sx00-1511-131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176367","type":"LOCAL"},{"code":"1082501","type":"LOCAL"}],"standard_charges":[{"gross_charge":12088.27,"discounted_cash":8461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176367 = Hospital System Supply Identifier | 1082501 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111330 TITANIUM 11X330MM","code_information":[{"code":"Sx00-1511-133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176675","type":"LOCAL"},{"code":"1082538","type":"LOCAL"}],"standard_charges":[{"gross_charge":12088.27,"discounted_cash":8461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176675 = Hospital System Supply Identifier | 1082538 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111345 TITANIUM 11X345MM","code_information":[{"code":"Sx00-1511-134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175855","type":"LOCAL"},{"code":"1082508","type":"LOCAL"}],"standard_charges":[{"gross_charge":12088.27,"discounted_cash":8461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175855 = Hospital System Supply Identifier | 1082508 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111360 TITANIUM 11X360MM","code_information":[{"code":"Sx00-1511-136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176522","type":"LOCAL"},{"code":"1082515","type":"LOCAL"}],"standard_charges":[{"gross_charge":12088.27,"discounted_cash":8461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176522 = Hospital System Supply Identifier | 1082515 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111375 TITANIUM 11X375MM","code_information":[{"code":"Sx00-1511-137","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176564","type":"LOCAL"},{"code":"1082557","type":"LOCAL"}],"standard_charges":[{"gross_charge":12088.27,"discounted_cash":8461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176564 = Hospital System Supply Identifier | 1082557 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111390 TITANIUM 11X390MM","code_information":[{"code":"Sx00-1511-139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176031","type":"LOCAL"},{"code":"1082488","type":"LOCAL"}],"standard_charges":[{"gross_charge":12088.27,"discounted_cash":8461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176031 = Hospital System Supply Identifier | 1082488 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111405 TITANIUM 11X405MM","code_information":[{"code":"Sx00-1511-140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176158","type":"LOCAL"},{"code":"1082472","type":"LOCAL"}],"standard_charges":[{"gross_charge":12088.27,"discounted_cash":8461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176158 = Hospital System Supply Identifier | 1082472 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015111420 TITANIUM 11X420MM","code_information":[{"code":"Sx00-1511-142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175772","type":"LOCAL"},{"code":"1082544","type":"LOCAL"}],"standard_charges":[{"gross_charge":12088.27,"discounted_cash":8461.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175772 = Hospital System Supply Identifier | 1082544 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112285 TITANIUM 12X285MM","code_information":[{"code":"Sx00-1511-228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175745","type":"LOCAL"},{"code":"1082462","type":"LOCAL"}],"standard_charges":[{"gross_charge":12383.11,"discounted_cash":8668.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175745 = Hospital System Supply Identifier | 1082462 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112300 TITANIUM 12X300MM","code_information":[{"code":"Sx00-1511-230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176682","type":"LOCAL"},{"code":"1082567","type":"LOCAL"}],"standard_charges":[{"gross_charge":12383.11,"discounted_cash":8668.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176682 = Hospital System Supply Identifier | 1082567 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112315 TITANIUM 12X315MM","code_information":[{"code":"Sx00-1511-231","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176604","type":"LOCAL"},{"code":"1082520","type":"LOCAL"}],"standard_charges":[{"gross_charge":12383.11,"discounted_cash":8668.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176604 = Hospital System Supply Identifier | 1082520 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112330 TITANIUM 12X330MM","code_information":[{"code":"Sx00-1511-233","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176164","type":"LOCAL"},{"code":"1082452","type":"LOCAL"}],"standard_charges":[{"gross_charge":12383.11,"discounted_cash":8668.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176164 = Hospital System Supply Identifier | 1082452 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112345 TITANIUM 12X345MM","code_information":[{"code":"Sx00-1511-234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176096","type":"LOCAL"},{"code":"1082434","type":"LOCAL"}],"standard_charges":[{"gross_charge":12383.11,"discounted_cash":8668.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176096 = Hospital System Supply Identifier | 1082434 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112360 TITANIUM 12X360MM","code_information":[{"code":"Sx00-1511-236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176505","type":"LOCAL"},{"code":"1082533","type":"LOCAL"}],"standard_charges":[{"gross_charge":12383.11,"discounted_cash":8668.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176505 = Hospital System Supply Identifier | 1082533 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112375 TITANIUM 12X375MM","code_information":[{"code":"Sx00-1511-237","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175982","type":"LOCAL"},{"code":"1082512","type":"LOCAL"}],"standard_charges":[{"gross_charge":12383.11,"discounted_cash":8668.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175982 = Hospital System Supply Identifier | 1082512 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112390 TITANIUM 12X390MM","code_information":[{"code":"Sx00-1511-239","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176240","type":"LOCAL"},{"code":"1082596","type":"LOCAL"}],"standard_charges":[{"gross_charge":12383.11,"discounted_cash":8668.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176240 = Hospital System Supply Identifier | 1082596 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112405 TITANIUM 12X405MM","code_information":[{"code":"Sx00-1511-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176227","type":"LOCAL"},{"code":"1082459","type":"LOCAL"}],"standard_charges":[{"gross_charge":12383.11,"discounted_cash":8668.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176227 = Hospital System Supply Identifier | 1082459 = Lawson ID"}]},{"description":"NAIL INTRAMEDULLARY BONE TIBIAL PNP TIBIA 0015112420 TITANIUM 12X420MM","code_information":[{"code":"Sx00-1511-242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176021","type":"LOCAL"},{"code":"1082564","type":"LOCAL"}],"standard_charges":[{"gross_charge":12383.11,"discounted_cash":8668.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176021 = Hospital System Supply Identifier | 1082564 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240025 4.0X25MM","code_information":[{"code":"Sx00-1524-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176291","type":"LOCAL"},{"code":"1082467","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176291 = Hospital System Supply Identifier | 1082467 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240020 4.0X20MM","code_information":[{"code":"Sx00-1524-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176666","type":"LOCAL"},{"code":"1082497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176666 = Hospital System Supply Identifier | 1082497 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240030 4.0X30MM","code_information":[{"code":"Sx00-1524-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176348","type":"LOCAL"},{"code":"1082558","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176348 = Hospital System Supply Identifier | 1082558 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240035 4.0X35MM","code_information":[{"code":"Sx00-1524-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175747","type":"LOCAL"},{"code":"1082519","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175747 = Hospital System Supply Identifier | 1082519 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240040 4.0X40MM","code_information":[{"code":"Sx00-1524-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176532","type":"LOCAL"},{"code":"1082455","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176532 = Hospital System Supply Identifier | 1082455 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240045 4.0X45MM","code_information":[{"code":"Sx00-1524-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176640","type":"LOCAL"},{"code":"1082565","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176640 = Hospital System Supply Identifier | 1082565 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240055 4.0X55MM","code_information":[{"code":"Sx00-1524-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176259","type":"LOCAL"},{"code":"1082444","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176259 = Hospital System Supply Identifier | 1082444 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240050 4.0X50MM","code_information":[{"code":"Sx00-1524-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176480","type":"LOCAL"},{"code":"1082583","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176480 = Hospital System Supply Identifier | 1082583 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240060 4.0X60MM","code_information":[{"code":"Sx00-1524-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176114","type":"LOCAL"},{"code":"1082539","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176114 = Hospital System Supply Identifier | 1082539 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240175 4.0X17.5MM","code_information":[{"code":"Sx00-1524-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176602","type":"LOCAL"},{"code":"1082514","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176602 = Hospital System Supply Identifier | 1082514 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240225 4.0X22.5MM","code_information":[{"code":"Sx00-1524-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176420","type":"LOCAL"},{"code":"1082578","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176420 = Hospital System Supply Identifier | 1082578 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240275 4.0X27.5MM","code_information":[{"code":"Sx00-1524-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176136","type":"LOCAL"},{"code":"1082465","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176136 = Hospital System Supply Identifier | 1082465 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240325 4.0X32.5MM","code_information":[{"code":"Sx00-1524-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176674","type":"LOCAL"},{"code":"1082494","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176674 = Hospital System Supply Identifier | 1082494 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240375 4.0X37.5MM","code_information":[{"code":"Sx00-1524-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176350","type":"LOCAL"},{"code":"1082573","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176350 = Hospital System Supply Identifier | 1082573 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240425 4.0X42.5MM","code_information":[{"code":"Sx00-1524-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176369","type":"LOCAL"},{"code":"1082529","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176369 = Hospital System Supply Identifier | 1082529 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240475 4.0X47.5MM","code_information":[{"code":"Sx00-1524-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176601","type":"LOCAL"},{"code":"1082442","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176601 = Hospital System Supply Identifier | 1082442 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240525 4.0X52.5MM","code_information":[{"code":"Sx00-1524-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176230","type":"LOCAL"},{"code":"1082478","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176230 = Hospital System Supply Identifier | 1082478 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015240575 4.0X57.5MM","code_information":[{"code":"Sx00-1524-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176456","type":"LOCAL"},{"code":"1082477","type":"LOCAL"}],"standard_charges":[{"gross_charge":1378.88,"discounted_cash":965.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176456 = Hospital System Supply Identifier | 1082477 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245020 4.5X20MM","code_information":[{"code":"Sx00-1524-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176159","type":"LOCAL"},{"code":"1082495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176159 = Hospital System Supply Identifier | 1082495 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245025 4.5X25MM","code_information":[{"code":"Sx00-1524-502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175998","type":"LOCAL"},{"code":"1082561","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175998 = Hospital System Supply Identifier | 1082561 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245035 4.5X35MM","code_information":[{"code":"Sx00-1524-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176515","type":"LOCAL"},{"code":"1082531","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176515 = Hospital System Supply Identifier | 1082531 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245030 4.5X30MM","code_information":[{"code":"Sx00-1524-503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176481","type":"LOCAL"},{"code":"1082590","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176481 = Hospital System Supply Identifier | 1082590 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245045 4.5X45MM","code_information":[{"code":"Sx00-1524-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175892","type":"LOCAL"},{"code":"1082523","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175892 = Hospital System Supply Identifier | 1082523 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245040 4.5X40MM","code_information":[{"code":"Sx00-1524-504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176457","type":"LOCAL"},{"code":"1082481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176457 = Hospital System Supply Identifier | 1082481 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245050 4.5X50MM","code_information":[{"code":"Sx00-1524-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176687","type":"LOCAL"},{"code":"1082468","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176687 = Hospital System Supply Identifier | 1082468 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245055 4.5X55MM","code_information":[{"code":"Sx00-1524-505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176507","type":"LOCAL"},{"code":"1082582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176507 = Hospital System Supply Identifier | 1082582 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245065 4.5X65MM","code_information":[{"code":"Sx00-1524-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176011","type":"LOCAL"},{"code":"1082553","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176011 = Hospital System Supply Identifier | 1082553 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245060 4.5X60MM","code_information":[{"code":"Sx00-1524-506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176258","type":"LOCAL"},{"code":"1082585","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176258 = Hospital System Supply Identifier | 1082585 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245070 4.5X70MM","code_information":[{"code":"Sx00-1524-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175797","type":"LOCAL"},{"code":"1082461","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175797 = Hospital System Supply Identifier | 1082461 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245075 4.5X75MM","code_information":[{"code":"Sx00-1524-507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175999","type":"LOCAL"},{"code":"1082587","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175999 = Hospital System Supply Identifier | 1082587 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245080 4.5X80MM","code_information":[{"code":"Sx00-1524-508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176563","type":"LOCAL"},{"code":"1082482","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176563 = Hospital System Supply Identifier | 1082482 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245175 4.5X17.5MM","code_information":[{"code":"Sx00-1524-517","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176479","type":"LOCAL"},{"code":"1082576","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176479 = Hospital System Supply Identifier | 1082576 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245225 4.5X22.5MM","code_information":[{"code":"Sx00-1524-522","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175798","type":"LOCAL"},{"code":"1082487","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175798 = Hospital System Supply Identifier | 1082487 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245275 4.5X27.5MM","code_information":[{"code":"Sx00-1524-527","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175852","type":"LOCAL"},{"code":"1082453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175852 = Hospital System Supply Identifier | 1082453 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245325 4.5X32.5MM","code_information":[{"code":"Sx00-1524-532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175808","type":"LOCAL"},{"code":"1082575","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175808 = Hospital System Supply Identifier | 1082575 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245375 4.5X37.5MM","code_information":[{"code":"Sx00-1524-537","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176116","type":"LOCAL"},{"code":"1082570","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176116 = Hospital System Supply Identifier | 1082570 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245425 4.5X42.5MM","code_information":[{"code":"Sx00-1524-542","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176117","type":"LOCAL"},{"code":"1082577","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176117 = Hospital System Supply Identifier | 1082577 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245475 4.5X47.5MM","code_information":[{"code":"Sx00-1524-547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176670","type":"LOCAL"},{"code":"1082450","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176670 = Hospital System Supply Identifier | 1082450 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245525 4.5X52.5MM","code_information":[{"code":"Sx00-1524-552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176292","type":"LOCAL"},{"code":"1082510","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176292 = Hospital System Supply Identifier | 1082510 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245575 4.5X57.5MM","code_information":[{"code":"Sx00-1524-557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176371","type":"LOCAL"},{"code":"1082592","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176371 = Hospital System Supply Identifier | 1082592 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245625 4.5X62.5MM","code_information":[{"code":"Sx00-1524-562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176254","type":"LOCAL"},{"code":"1082502","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176254 = Hospital System Supply Identifier | 1082502 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245675 4.5X67.5MM","code_information":[{"code":"Sx00-1524-567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176551","type":"LOCAL"},{"code":"1082594","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176551 = Hospital System Supply Identifier | 1082594 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245725 4.5X72.5MM","code_information":[{"code":"Sx00-1524-572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176508","type":"LOCAL"},{"code":"1082562","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176508 = Hospital System Supply Identifier | 1082562 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015245775 4.5X77.5MM","code_information":[{"code":"Sx00-1524-577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176622","type":"LOCAL"},{"code":"1082589","type":"LOCAL"}],"standard_charges":[{"gross_charge":1423.09,"discounted_cash":996.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176622 = Hospital System Supply Identifier | 1082589 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250025 5.0X25MM","code_information":[{"code":"Sx00-1525-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175775","type":"LOCAL"},{"code":"1082463","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175775 = Hospital System Supply Identifier | 1082463 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250020 5.0X20MM","code_information":[{"code":"Sx00-1525-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176696","type":"LOCAL"},{"code":"1082454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176696 = Hospital System Supply Identifier | 1082454 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250030 5.0X30MM","code_information":[{"code":"Sx00-1525-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176387","type":"LOCAL"},{"code":"1082492","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176387 = Hospital System Supply Identifier | 1082492 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250035 5.0X35MM","code_information":[{"code":"Sx00-1525-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176012","type":"LOCAL"},{"code":"1082548","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176012 = Hospital System Supply Identifier | 1082548 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250045 5.0X45MM","code_information":[{"code":"Sx00-1525-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176533","type":"LOCAL"},{"code":"1082491","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176533 = Hospital System Supply Identifier | 1082491 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250040 5.0X40MM","code_information":[{"code":"Sx00-1525-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175773","type":"LOCAL"},{"code":"1082584","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175773 = Hospital System Supply Identifier | 1082584 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250055 5.0X55MM","code_information":[{"code":"Sx00-1525-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176384","type":"LOCAL"},{"code":"1082438","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176384 = Hospital System Supply Identifier | 1082438 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250050 5.0X50MM","code_information":[{"code":"Sx00-1525-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176641","type":"LOCAL"},{"code":"1082579","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176641 = Hospital System Supply Identifier | 1082579 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250060 5.0X60MM","code_information":[{"code":"Sx00-1525-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176290","type":"LOCAL"},{"code":"1082435","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176290 = Hospital System Supply Identifier | 1082435 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250065 5.0X65MM","code_information":[{"code":"Sx00-1525-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176349","type":"LOCAL"},{"code":"1082588","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176349 = Hospital System Supply Identifier | 1082588 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250070 5.0X70MM","code_information":[{"code":"Sx00-1525-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175851","type":"LOCAL"},{"code":"1082818","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175851 = Hospital System Supply Identifier | 1082818 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250075 5.0X75MM","code_information":[{"code":"Sx00-1525-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176328","type":"LOCAL"},{"code":"1082758","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176328 = Hospital System Supply Identifier | 1082758 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250080 5.0X80MM","code_information":[{"code":"Sx00-1525-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175869","type":"LOCAL"},{"code":"1082669","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175869 = Hospital System Supply Identifier | 1082669 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250175 5.0X17.5MM","code_information":[{"code":"Sx00-1525-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176596","type":"LOCAL"},{"code":"1082730","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176596 = Hospital System Supply Identifier | 1082730 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250225 5.0X22.5MM","code_information":[{"code":"Sx00-1525-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175807","type":"LOCAL"},{"code":"1082805","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175807 = Hospital System Supply Identifier | 1082805 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250275 5.0X27.5MM","code_information":[{"code":"Sx00-1525-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176209","type":"LOCAL"},{"code":"1082831","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176209 = Hospital System Supply Identifier | 1082831 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250325 5.0X32.5MM","code_information":[{"code":"Sx00-1525-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175740","type":"LOCAL"},{"code":"1082854","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175740 = Hospital System Supply Identifier | 1082854 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250375 5.0X37.5MM","code_information":[{"code":"Sx00-1525-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176633","type":"LOCAL"},{"code":"1082635","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176633 = Hospital System Supply Identifier | 1082635 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250425 5.0X42.5MM","code_information":[{"code":"Sx00-1525-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176001","type":"LOCAL"},{"code":"1082632","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176001 = Hospital System Supply Identifier | 1082632 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250475 5.0X47.5MM","code_information":[{"code":"Sx00-1525-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176346","type":"LOCAL"},{"code":"1082620","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176346 = Hospital System Supply Identifier | 1082620 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250525 5.0X52.5MM","code_information":[{"code":"Sx00-1525-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176627","type":"LOCAL"},{"code":"1082697","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176627 = Hospital System Supply Identifier | 1082697 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250575 5.0X57.5MM","code_information":[{"code":"Sx00-1525-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176095","type":"LOCAL"},{"code":"1082728","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176095 = Hospital System Supply Identifier | 1082728 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250625 5.0X62.5MM","code_information":[{"code":"Sx00-1525-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176490","type":"LOCAL"},{"code":"1082651","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176490 = Hospital System Supply Identifier | 1082651 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250675 5.0X67.5MM","code_information":[{"code":"Sx00-1525-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176652","type":"LOCAL"},{"code":"1082832","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176652 = Hospital System Supply Identifier | 1082832 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250725 5.0X72.5MM","code_information":[{"code":"Sx00-1525-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176244","type":"LOCAL"},{"code":"1082699","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176244 = Hospital System Supply Identifier | 1082699 = Lawson ID"}]},{"description":"SCREW BONE LOCKING CANNULATED TIBIAL PNP TIBIA 0015250775 5.0X77.5MM","code_information":[{"code":"Sx00-1525-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176470","type":"LOCAL"},{"code":"1082653","type":"LOCAL"}],"standard_charges":[{"gross_charge":1637.44,"discounted_cash":1146.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176470 = Hospital System Supply Identifier | 1082653 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL FLUSH PNP TIBIA 0015300000","code_information":[{"code":"Sx00-1530-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175976","type":"LOCAL"},{"code":"1082637","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175976 = Hospital System Supply Identifier | 1082637 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015300005 9.75X5MM","code_information":[{"code":"Sx00-1530-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175732","type":"LOCAL"},{"code":"1082721","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175732 = Hospital System Supply Identifier | 1082721 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015300015 9.75X15MM","code_information":[{"code":"Sx00-1530-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175868","type":"LOCAL"},{"code":"1082627","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175868 = Hospital System Supply Identifier | 1082627 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015300010 9.75X10MM","code_information":[{"code":"Sx00-1530-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176634","type":"LOCAL"},{"code":"1082808","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176634 = Hospital System Supply Identifier | 1082808 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301005 10.5X5MM","code_information":[{"code":"Sx00-1530-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176319","type":"LOCAL"},{"code":"1082816","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176319 = Hospital System Supply Identifier | 1082816 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301015 10.5X15MM","code_information":[{"code":"Sx00-1530-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175956","type":"LOCAL"},{"code":"1082710","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175956 = Hospital System Supply Identifier | 1082710 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301010 10.5X10MM","code_information":[{"code":"Sx00-1530-101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176078","type":"LOCAL"},{"code":"1082701","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176078 = Hospital System Supply Identifier | 1082701 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301105 11X5MM","code_information":[{"code":"Sx00-1530-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176208","type":"LOCAL"},{"code":"1082822","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176208 = Hospital System Supply Identifier | 1082822 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301115 11X15MM","code_information":[{"code":"Sx00-1530-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176079","type":"LOCAL"},{"code":"1082706","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176079 = Hospital System Supply Identifier | 1082706 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301110 11X10MM","code_information":[{"code":"Sx00-1530-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176382","type":"LOCAL"},{"code":"1082843","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176382 = Hospital System Supply Identifier | 1082843 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301205 12X5MM","code_information":[{"code":"Sx00-1530-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176540","type":"LOCAL"},{"code":"1082631","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176540 = Hospital System Supply Identifier | 1082631 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301210 12X10MM","code_information":[{"code":"Sx00-1530-121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1175979","type":"LOCAL"},{"code":"1082693","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1175979 = Hospital System Supply Identifier | 1082693 = Lawson ID"}]},{"description":"ENDCAP INTRAMEDULLARY NAIL CANNULATED PNP TIBIA 0015301215 12X15MM","code_information":[{"code":"Sx00-1530-121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1176430","type":"LOCAL"},{"code":"1082844","type":"LOCAL"}],"standard_charges":[{"gross_charge":1388.9,"discounted_cash":972.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1176430 = Hospital System Supply Identifier | 1082844 = Lawson ID"}]},{"description":"DISC - COLLAR CERV PHILA 2P MED 4.25","code_information":[{"code":"Sx00-1741-011","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0120","type":"HCPCS"},{"code":"36517","type":"LOCAL"},{"code":"106761","type":"LOCAL"}],"standard_charges":[{"gross_charge":221.25,"discounted_cash":154.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 36517 = Hospital System Supply Identifier | 106761 = Lawson ID"}]},{"description":"REAMER FLEX IM 12.5MM DIA","code_information":[{"code":"Sx00-2228-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"384872","type":"LOCAL"},{"code":"459165","type":"LOCAL"}],"standard_charges":[{"gross_charge":1582.4,"discounted_cash":1107.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384872 = Hospital System Supply Identifier | 459165 = Lawson ID"}]},{"description":"REAMER FLEX IM 13.5MM DIA","code_information":[{"code":"Sx00-2228-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"384874","type":"LOCAL"},{"code":"459167","type":"LOCAL"}],"standard_charges":[{"gross_charge":1582.4,"discounted_cash":1107.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384874 = Hospital System Supply Identifier | 459167 = Lawson ID"}]},{"description":"REAMER FLEX IM 13MM DIA","code_information":[{"code":"Sx00-2228-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"384873","type":"LOCAL"},{"code":"459166","type":"LOCAL"}],"standard_charges":[{"gross_charge":1582.4,"discounted_cash":1107.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384873 = Hospital System Supply Identifier | 459166 = Lawson ID"}]},{"description":"REAMER FLEX IM 14MM DIA","code_information":[{"code":"Sx00-2228-014","type":"CDM"},{"code":"272","type":"RC"},{"code":"384875","type":"LOCAL"},{"code":"459168","type":"LOCAL"}],"standard_charges":[{"gross_charge":1582.4,"discounted_cash":1107.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384875 = Hospital System Supply Identifier | 459168 = Lawson ID"}]},{"description":"REAMER SURGICAL 24MM FLEXIBLE","code_information":[{"code":"Sx00-2228-024","type":"CDM"},{"code":"272","type":"RC"},{"code":"37345","type":"LOCAL"},{"code":"158616","type":"LOCAL"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37345 = Hospital System Supply Identifier | 158616 = Lawson ID"}]},{"description":"INST CABLE-READY SET","code_information":[{"code":"Sx00-2232-000","type":"CDM"},{"code":"272","type":"RC"},{"code":"691186","type":"LOCAL"},{"code":"452346","type":"LOCAL"}],"standard_charges":[{"gross_charge":16816.8,"discounted_cash":11771.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 691186 = Hospital System Supply Identifier | 452346 = Lawson ID"}]},{"description":"BUTTON HEX 2.5MM 2232-01-25","code_information":[{"code":"Sx00-2232-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2351","type":"LOCAL"},{"code":"339930","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2351 = Hospital System Supply Identifier | 339930 = Lawson ID"}]},{"description":"BUTTON HEX SS 5.0MM","code_information":[{"code":"Sx00-2232-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384640","type":"LOCAL"},{"code":"416866","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384640 = Hospital System Supply Identifier | 416866 = Lawson ID"}]},{"description":"CBL DEV GTR LNG W/O CBL","code_information":[{"code":"Sx00-2232-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"37048","type":"LOCAL"},{"code":"144555","type":"LOCAL"}],"standard_charges":[{"gross_charge":4650.45,"discounted_cash":3255.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37048 = Hospital System Supply Identifier | 144555 = Lawson ID"}]},{"description":"BUTTON BONE GRIP CABLE READY 00223200225 TITANIUM 2.5MM","code_information":[{"code":"Sx00-2232-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1012002","type":"LOCAL"},{"code":"1002959","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1012002 = Hospital System Supply Identifier | 1002959 = Lawson ID"}]},{"description":"BUTTON HEX SNGL 5.0MM","code_information":[{"code":"Sx00-2232-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"190623","type":"LOCAL"},{"code":"462060","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 190623 = Hospital System Supply Identifier | 462060 = Lawson ID"}]},{"description":"IMP CABLE SS 1.3 X 560MM","code_information":[{"code":"Sx00-2232-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"23199","type":"LOCAL"},{"code":"245979","type":"LOCAL"}],"standard_charges":[{"gross_charge":1247.0,"discounted_cash":872.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23199 = Hospital System Supply Identifier | 245979 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-21","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68379","type":"LOCAL"},{"code":"206454","type":"LOCAL"}],"standard_charges":[{"gross_charge":1219.82,"discounted_cash":853.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68379 = Hospital System Supply Identifier | 206454 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-18","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68378","type":"LOCAL"},{"code":"206453","type":"LOCAL"}],"standard_charges":[{"gross_charge":1219.82,"discounted_cash":853.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68378 = Hospital System Supply Identifier | 206453 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-19","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68377","type":"LOCAL"},{"code":"206450","type":"LOCAL"}],"standard_charges":[{"gross_charge":1219.82,"discounted_cash":853.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68377 = Hospital System Supply Identifier | 206450 = Lawson ID"}]},{"description":"PIN CABLE READY 2232-50-20","code_information":[{"code":"Sx00-2232-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68376","type":"LOCAL"},{"code":"206449","type":"LOCAL"}],"standard_charges":[{"gross_charge":1219.82,"discounted_cash":853.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68376 = Hospital System Supply Identifier | 206449 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X480MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68221","type":"LOCAL"},{"code":"205439","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68221 = Hospital System Supply Identifier | 205439 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X460MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68220","type":"LOCAL"},{"code":"205438","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68220 = Hospital System Supply Identifier | 205438 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X440MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68219","type":"LOCAL"},{"code":"205437","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68219 = Hospital System Supply Identifier | 205437 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X420MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68218","type":"LOCAL"},{"code":"205436","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68218 = Hospital System Supply Identifier | 205436 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X400MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68217","type":"LOCAL"},{"code":"205435","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68217 = Hospital System Supply Identifier | 205435 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X380MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68216","type":"LOCAL"},{"code":"205434","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68216 = Hospital System Supply Identifier | 205434 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X360MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68215","type":"LOCAL"},{"code":"205433","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68215 = Hospital System Supply Identifier | 205433 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X340MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53400","type":"LOCAL"},{"code":"205431","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53400 = Hospital System Supply Identifier | 205431 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X320MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68214","type":"LOCAL"},{"code":"205430","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68214 = Hospital System Supply Identifier | 205430 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X260MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68211","type":"LOCAL"},{"code":"205427","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68211 = Hospital System Supply Identifier | 205427 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X280MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68212","type":"LOCAL"},{"code":"205428","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68212 = Hospital System Supply Identifier | 205428 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X240MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68210","type":"LOCAL"},{"code":"205426","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68210 = Hospital System Supply Identifier | 205426 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X220MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68176","type":"LOCAL"},{"code":"205391","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68176 = Hospital System Supply Identifier | 205391 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X200MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68174","type":"LOCAL"},{"code":"205389","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68174 = Hospital System Supply Identifier | 205389 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X180MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68171","type":"LOCAL"},{"code":"205386","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68171 = Hospital System Supply Identifier | 205386 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X160MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68167","type":"LOCAL"},{"code":"205382","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68167 = Hospital System Supply Identifier | 205382 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X140MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68164","type":"LOCAL"},{"code":"205379","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68164 = Hospital System Supply Identifier | 205379 = Lawson ID"}]},{"description":"NAIL FEM SS RG 9X300MM","code_information":[{"code":"Sx00-2240-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68213","type":"LOCAL"},{"code":"205429","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68213 = Hospital System Supply Identifier | 205429 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X240MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68227","type":"LOCAL"},{"code":"205445","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68227 = Hospital System Supply Identifier | 205445 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X260MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68228","type":"LOCAL"},{"code":"205446","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68228 = Hospital System Supply Identifier | 205446 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X280MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68229","type":"LOCAL"},{"code":"205447","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68229 = Hospital System Supply Identifier | 205447 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X360MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68233","type":"LOCAL"},{"code":"205451","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68233 = Hospital System Supply Identifier | 205451 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X320MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68231","type":"LOCAL"},{"code":"205449","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68231 = Hospital System Supply Identifier | 205449 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X340MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68232","type":"LOCAL"},{"code":"205450","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68232 = Hospital System Supply Identifier | 205450 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X220MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68226","type":"LOCAL"},{"code":"205444","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68226 = Hospital System Supply Identifier | 205444 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X300MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68230","type":"LOCAL"},{"code":"205448","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68230 = Hospital System Supply Identifier | 205448 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X180MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68224","type":"LOCAL"},{"code":"205442","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68224 = Hospital System Supply Identifier | 205442 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X440MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68042","type":"LOCAL"},{"code":"205252","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68042 = Hospital System Supply Identifier | 205252 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X160MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68223","type":"LOCAL"},{"code":"205441","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68223 = Hospital System Supply Identifier | 205441 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X380MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68037","type":"LOCAL"},{"code":"205247","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68037 = Hospital System Supply Identifier | 205247 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X400MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68039","type":"LOCAL"},{"code":"205249","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68039 = Hospital System Supply Identifier | 205249 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X420MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68041","type":"LOCAL"},{"code":"205251","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68041 = Hospital System Supply Identifier | 205251 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X200MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68225","type":"LOCAL"},{"code":"205443","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68225 = Hospital System Supply Identifier | 205443 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X460MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68043","type":"LOCAL"},{"code":"205253","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68043 = Hospital System Supply Identifier | 205253 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X480MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68045","type":"LOCAL"},{"code":"205255","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68045 = Hospital System Supply Identifier | 205255 = Lawson ID"}]},{"description":"NAIL FEM SS RG 10X140MM","code_information":[{"code":"Sx00-2240-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68222","type":"LOCAL"},{"code":"205440","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68222 = Hospital System Supply Identifier | 205440 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X480MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68088","type":"LOCAL"},{"code":"205299","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68088 = Hospital System Supply Identifier | 205299 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X460MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68087","type":"LOCAL"},{"code":"205298","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68087 = Hospital System Supply Identifier | 205298 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X440MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68086","type":"LOCAL"},{"code":"205297","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68086 = Hospital System Supply Identifier | 205297 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X400MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68084","type":"LOCAL"},{"code":"205295","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68084 = Hospital System Supply Identifier | 205295 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X380MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68081","type":"LOCAL"},{"code":"205292","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68081 = Hospital System Supply Identifier | 205292 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X360MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68079","type":"LOCAL"},{"code":"205290","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68079 = Hospital System Supply Identifier | 205290 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X340MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68077","type":"LOCAL"},{"code":"205288","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68077 = Hospital System Supply Identifier | 205288 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X300MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68072","type":"LOCAL"},{"code":"205282","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68072 = Hospital System Supply Identifier | 205282 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X420MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68078","type":"LOCAL"},{"code":"205289","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68078 = Hospital System Supply Identifier | 205289 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X140MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68048","type":"LOCAL"},{"code":"205258","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68048 = Hospital System Supply Identifier | 205258 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X280MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68071","type":"LOCAL"},{"code":"205281","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68071 = Hospital System Supply Identifier | 205281 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X160MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68050","type":"LOCAL"},{"code":"205260","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68050 = Hospital System Supply Identifier | 205260 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X180MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68059","type":"LOCAL"},{"code":"205269","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68059 = Hospital System Supply Identifier | 205269 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X200MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68060","type":"LOCAL"},{"code":"205270","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68060 = Hospital System Supply Identifier | 205270 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X320MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68076","type":"LOCAL"},{"code":"205286","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68076 = Hospital System Supply Identifier | 205286 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X240MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68069","type":"LOCAL"},{"code":"205279","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68069 = Hospital System Supply Identifier | 205279 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X260MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68070","type":"LOCAL"},{"code":"205280","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68070 = Hospital System Supply Identifier | 205280 = Lawson ID"}]},{"description":"NAIL FEM SS RG 11X220MM","code_information":[{"code":"Sx00-2240-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68067","type":"LOCAL"},{"code":"205277","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68067 = Hospital System Supply Identifier | 205277 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X480MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68135","type":"LOCAL"},{"code":"205348","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68135 = Hospital System Supply Identifier | 205348 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X460MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68134","type":"LOCAL"},{"code":"205347","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68134 = Hospital System Supply Identifier | 205347 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X440MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68133","type":"LOCAL"},{"code":"205346","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68133 = Hospital System Supply Identifier | 205346 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X420MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68131","type":"LOCAL"},{"code":"205344","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68131 = Hospital System Supply Identifier | 205344 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X400MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68127","type":"LOCAL"},{"code":"205340","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68127 = Hospital System Supply Identifier | 205340 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X380MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68123","type":"LOCAL"},{"code":"205336","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68123 = Hospital System Supply Identifier | 205336 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X360MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68120","type":"LOCAL"},{"code":"205332","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68120 = Hospital System Supply Identifier | 205332 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X340MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68113","type":"LOCAL"},{"code":"205325","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68113 = Hospital System Supply Identifier | 205325 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X320MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68109","type":"LOCAL"},{"code":"205321","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68109 = Hospital System Supply Identifier | 205321 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X300MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68107","type":"LOCAL"},{"code":"205319","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68107 = Hospital System Supply Identifier | 205319 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X260MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68101","type":"LOCAL"},{"code":"205313","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68101 = Hospital System Supply Identifier | 205313 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X140MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68091","type":"LOCAL"},{"code":"205302","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68091 = Hospital System Supply Identifier | 205302 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X160MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68093","type":"LOCAL"},{"code":"205304","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68093 = Hospital System Supply Identifier | 205304 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X180MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68094","type":"LOCAL"},{"code":"205305","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68094 = Hospital System Supply Identifier | 205305 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X280MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68102","type":"LOCAL"},{"code":"205314","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68102 = Hospital System Supply Identifier | 205314 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X220MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68099","type":"LOCAL"},{"code":"205311","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68099 = Hospital System Supply Identifier | 205311 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X240MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68100","type":"LOCAL"},{"code":"205312","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68100 = Hospital System Supply Identifier | 205312 = Lawson ID"}]},{"description":"NAIL FEM SS RG 12X200MM","code_information":[{"code":"Sx00-2240-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68096","type":"LOCAL"},{"code":"205307","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68096 = Hospital System Supply Identifier | 205307 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X480MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68238","type":"LOCAL"},{"code":"205456","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68238 = Hospital System Supply Identifier | 205456 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X320MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68158","type":"LOCAL"},{"code":"205371","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68158 = Hospital System Supply Identifier | 205371 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X440MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68236","type":"LOCAL"},{"code":"205454","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68236 = Hospital System Supply Identifier | 205454 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X420MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68235","type":"LOCAL"},{"code":"205453","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68235 = Hospital System Supply Identifier | 205453 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X400MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68234","type":"LOCAL"},{"code":"205452","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68234 = Hospital System Supply Identifier | 205452 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X380MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68163","type":"LOCAL"},{"code":"205378","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68163 = Hospital System Supply Identifier | 205378 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X360MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68162","type":"LOCAL"},{"code":"205376","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68162 = Hospital System Supply Identifier | 205376 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X340MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53398","type":"LOCAL"},{"code":"205375","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53398 = Hospital System Supply Identifier | 205375 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X460MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68237","type":"LOCAL"},{"code":"205455","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68237 = Hospital System Supply Identifier | 205455 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X300MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68157","type":"LOCAL"},{"code":"205370","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68157 = Hospital System Supply Identifier | 205370 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X260MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68155","type":"LOCAL"},{"code":"205368","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68155 = Hospital System Supply Identifier | 205368 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X240MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68148","type":"LOCAL"},{"code":"205361","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68148 = Hospital System Supply Identifier | 205361 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X220MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68147","type":"LOCAL"},{"code":"205360","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68147 = Hospital System Supply Identifier | 205360 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X200MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68142","type":"LOCAL"},{"code":"205355","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68142 = Hospital System Supply Identifier | 205355 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X180MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68138","type":"LOCAL"},{"code":"205351","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68138 = Hospital System Supply Identifier | 205351 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X160MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68137","type":"LOCAL"},{"code":"205350","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68137 = Hospital System Supply Identifier | 205350 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X140MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68136","type":"LOCAL"},{"code":"205349","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68136 = Hospital System Supply Identifier | 205349 = Lawson ID"}]},{"description":"NAIL FEM SS RG 13X280MM","code_information":[{"code":"Sx00-2240-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68156","type":"LOCAL"},{"code":"205369","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68156 = Hospital System Supply Identifier | 205369 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X340MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68249","type":"LOCAL"},{"code":"205467","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68249 = Hospital System Supply Identifier | 205467 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X460MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68255","type":"LOCAL"},{"code":"205473","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68255 = Hospital System Supply Identifier | 205473 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X440MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68254","type":"LOCAL"},{"code":"205472","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68254 = Hospital System Supply Identifier | 205472 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X420MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68253","type":"LOCAL"},{"code":"205471","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68253 = Hospital System Supply Identifier | 205471 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X400MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68252","type":"LOCAL"},{"code":"205470","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68252 = Hospital System Supply Identifier | 205470 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X380MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68251","type":"LOCAL"},{"code":"205469","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68251 = Hospital System Supply Identifier | 205469 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X360MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68250","type":"LOCAL"},{"code":"205468","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68250 = Hospital System Supply Identifier | 205468 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X320MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68248","type":"LOCAL"},{"code":"205466","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68248 = Hospital System Supply Identifier | 205466 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X480MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68256","type":"LOCAL"},{"code":"205474","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68256 = Hospital System Supply Identifier | 205474 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X280MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68246","type":"LOCAL"},{"code":"205464","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68246 = Hospital System Supply Identifier | 205464 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X260MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68245","type":"LOCAL"},{"code":"205463","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68245 = Hospital System Supply Identifier | 205463 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X240MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68244","type":"LOCAL"},{"code":"205462","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68244 = Hospital System Supply Identifier | 205462 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X220MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68243","type":"LOCAL"},{"code":"205461","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68243 = Hospital System Supply Identifier | 205461 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X200MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68242","type":"LOCAL"},{"code":"205460","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68242 = Hospital System Supply Identifier | 205460 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X180MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68241","type":"LOCAL"},{"code":"205459","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68241 = Hospital System Supply Identifier | 205459 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X160MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68240","type":"LOCAL"},{"code":"205458","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68240 = Hospital System Supply Identifier | 205458 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X140MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68239","type":"LOCAL"},{"code":"205457","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68239 = Hospital System Supply Identifier | 205457 = Lawson ID"}]},{"description":"NAIL FEM SS RG 14X300MM","code_information":[{"code":"Sx00-2240-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68247","type":"LOCAL"},{"code":"205465","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68247 = Hospital System Supply Identifier | 205465 = Lawson ID"}]},{"description":"NUT CORTICAL LOCK 2240-50","code_information":[{"code":"Sx00-2240-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68279","type":"LOCAL"},{"code":"205508","type":"LOCAL"}],"standard_charges":[{"gross_charge":738.9,"discounted_cash":517.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68279 = Hospital System Supply Identifier | 205508 = Lawson ID"}]},{"description":"DISC - BIT DRILL PROX TIP 5.0 MM","code_information":[{"code":"Sx00-2241-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"26250","type":"LOCAL"},{"code":"303893","type":"LOCAL"}],"standard_charges":[{"gross_charge":738.4,"discounted_cash":516.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 26250 = Hospital System Supply Identifier | 303893 = Lawson ID"}]},{"description":"DISC - DRILL STOP PILOT TIP PROX 3.7","code_information":[{"code":"Sx00-2241-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"383161","type":"LOCAL"},{"code":"155952","type":"LOCAL"}],"standard_charges":[{"gross_charge":738.4,"discounted_cash":516.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383161 = Hospital System Supply Identifier | 155952 = Lawson ID"}]},{"description":"CAP NAIL FLUSH","code_information":[{"code":"Sx00-2252-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"60065","type":"LOCAL"},{"code":"146487","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 60065 = Hospital System Supply Identifier | 146487 = Lawson ID"}]},{"description":"CAP NAIL EXTENDED 5MM","code_information":[{"code":"Sx00-2252-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53280","type":"LOCAL"},{"code":"146488","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53280 = Hospital System Supply Identifier | 146488 = Lawson ID"}]},{"description":"CAP NAIL EXTENDED 10MM","code_information":[{"code":"Sx00-2252-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"60066","type":"LOCAL"},{"code":"146489","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 60066 = Hospital System Supply Identifier | 146489 = Lawson ID"}]},{"description":"CAP NAIL EXTENDED 15MM","code_information":[{"code":"Sx00-2252-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53281","type":"LOCAL"},{"code":"146490","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53281 = Hospital System Supply Identifier | 146490 = Lawson ID"}]},{"description":"NO USAGE - WASHER ORTHO 13 MM M/DN","code_information":[{"code":"Sx00-2252-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68278","type":"LOCAL"},{"code":"205506","type":"LOCAL"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":230.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68278 = Hospital System Supply Identifier | 205506 = Lawson ID"}]},{"description":"CAP NAIL HUM LCK","code_information":[{"code":"Sx00-2252-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"60237","type":"LOCAL"},{"code":"205507","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 60237 = Hospital System Supply Identifier | 205507 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X60MM","code_information":[{"code":"Sx00-2252-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65203","type":"LOCAL"},{"code":"146491","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65203 = Hospital System Supply Identifier | 146491 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X65MM","code_information":[{"code":"Sx00-2252-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65204","type":"LOCAL"},{"code":"146492","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65204 = Hospital System Supply Identifier | 146492 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X70MM","code_information":[{"code":"Sx00-2252-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65205","type":"LOCAL"},{"code":"146493","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65205 = Hospital System Supply Identifier | 146493 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X75MM","code_information":[{"code":"Sx00-2252-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65206","type":"LOCAL"},{"code":"146494","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65206 = Hospital System Supply Identifier | 146494 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X80MM","code_information":[{"code":"Sx00-2252-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65207","type":"LOCAL"},{"code":"146495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65207 = Hospital System Supply Identifier | 146495 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X85MM","code_information":[{"code":"Sx00-2252-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65208","type":"LOCAL"},{"code":"146496","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65208 = Hospital System Supply Identifier | 146496 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X90MM","code_information":[{"code":"Sx00-2252-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53282","type":"LOCAL"},{"code":"146497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53282 = Hospital System Supply Identifier | 146497 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X95MM","code_information":[{"code":"Sx00-2252-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53283","type":"LOCAL"},{"code":"146498","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53283 = Hospital System Supply Identifier | 146498 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X100MM","code_information":[{"code":"Sx00-2252-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65209","type":"LOCAL"},{"code":"146499","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65209 = Hospital System Supply Identifier | 146499 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X105MM","code_information":[{"code":"Sx00-2252-105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65210","type":"LOCAL"},{"code":"146500","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65210 = Hospital System Supply Identifier | 146500 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X110MM","code_information":[{"code":"Sx00-2252-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65211","type":"LOCAL"},{"code":"146501","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65211 = Hospital System Supply Identifier | 146501 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X115MM","code_information":[{"code":"Sx00-2252-115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65212","type":"LOCAL"},{"code":"146502","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65212 = Hospital System Supply Identifier | 146502 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X120MM","code_information":[{"code":"Sx00-2252-120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65213","type":"LOCAL"},{"code":"146503","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65213 = Hospital System Supply Identifier | 146503 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X125MM","code_information":[{"code":"Sx00-2252-125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65214","type":"LOCAL"},{"code":"146504","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65214 = Hospital System Supply Identifier | 146504 = Lawson ID"}]},{"description":"SCREW RECON M/DN 5.5X130MM","code_information":[{"code":"Sx00-2252-130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65215","type":"LOCAL"},{"code":"146505","type":"LOCAL"}],"standard_charges":[{"gross_charge":1124.66,"discounted_cash":787.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65215 = Hospital System Supply Identifier | 146505 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68063","type":"LOCAL"},{"code":"205273","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68063 = Hospital System Supply Identifier | 205273 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68054","type":"LOCAL"},{"code":"205264","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68054 = Hospital System Supply Identifier | 205264 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68075","type":"LOCAL"},{"code":"205285","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68075 = Hospital System Supply Identifier | 205285 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68033","type":"LOCAL"},{"code":"205243","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68033 = Hospital System Supply Identifier | 205243 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68022","type":"LOCAL"},{"code":"205232","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68022 = Hospital System Supply Identifier | 205232 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X240MM","code_information":[{"code":"Sx00-2252-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68044","type":"LOCAL"},{"code":"205254","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68044 = Hospital System Supply Identifier | 205254 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68023","type":"LOCAL"},{"code":"205233","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68023 = Hospital System Supply Identifier | 205233 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68034","type":"LOCAL"},{"code":"205244","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68034 = Hospital System Supply Identifier | 205244 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68046","type":"LOCAL"},{"code":"205256","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68046 = Hospital System Supply Identifier | 205256 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68055","type":"LOCAL"},{"code":"205265","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68055 = Hospital System Supply Identifier | 205265 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68064","type":"LOCAL"},{"code":"205274","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68064 = Hospital System Supply Identifier | 205274 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X260MM","code_information":[{"code":"Sx00-2252-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68080","type":"LOCAL"},{"code":"205291","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68080 = Hospital System Supply Identifier | 205291 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68065","type":"LOCAL"},{"code":"205275","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68065 = Hospital System Supply Identifier | 205275 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68082","type":"LOCAL"},{"code":"205293","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68082 = Hospital System Supply Identifier | 205293 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68056","type":"LOCAL"},{"code":"205266","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68056 = Hospital System Supply Identifier | 205266 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68092","type":"LOCAL"},{"code":"205303","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68092 = Hospital System Supply Identifier | 205303 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68035","type":"LOCAL"},{"code":"205245","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68035 = Hospital System Supply Identifier | 205245 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68024","type":"LOCAL"},{"code":"205234","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68024 = Hospital System Supply Identifier | 205234 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X280MM","code_information":[{"code":"Sx00-2252-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68047","type":"LOCAL"},{"code":"205257","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68047 = Hospital System Supply Identifier | 205257 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68026","type":"LOCAL"},{"code":"205236","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68026 = Hospital System Supply Identifier | 205236 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68036","type":"LOCAL"},{"code":"205246","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68036 = Hospital System Supply Identifier | 205246 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68049","type":"LOCAL"},{"code":"205259","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68049 = Hospital System Supply Identifier | 205259 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68057","type":"LOCAL"},{"code":"205267","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68057 = Hospital System Supply Identifier | 205267 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68066","type":"LOCAL"},{"code":"205276","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68066 = Hospital System Supply Identifier | 205276 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68083","type":"LOCAL"},{"code":"205294","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68083 = Hospital System Supply Identifier | 205294 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68095","type":"LOCAL"},{"code":"205306","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68095 = Hospital System Supply Identifier | 205306 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68105","type":"LOCAL"},{"code":"205317","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68105 = Hospital System Supply Identifier | 205317 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X300MM","code_information":[{"code":"Sx00-2252-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68119","type":"LOCAL"},{"code":"205331","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68119 = Hospital System Supply Identifier | 205331 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68121","type":"LOCAL"},{"code":"205333","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68121 = Hospital System Supply Identifier | 205333 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68106","type":"LOCAL"},{"code":"205318","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68106 = Hospital System Supply Identifier | 205318 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68097","type":"LOCAL"},{"code":"205308","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68097 = Hospital System Supply Identifier | 205308 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68085","type":"LOCAL"},{"code":"205296","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68085 = Hospital System Supply Identifier | 205296 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65216","type":"LOCAL"},{"code":"146506","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65216 = Hospital System Supply Identifier | 146506 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68058","type":"LOCAL"},{"code":"205268","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68058 = Hospital System Supply Identifier | 205268 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68025","type":"LOCAL"},{"code":"205235","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68025 = Hospital System Supply Identifier | 205235 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65222","type":"LOCAL"},{"code":"146512","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65222 = Hospital System Supply Identifier | 146512 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X320MM","code_information":[{"code":"Sx00-2252-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68068","type":"LOCAL"},{"code":"205278","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68068 = Hospital System Supply Identifier | 205278 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68098","type":"LOCAL"},{"code":"205309","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68098 = Hospital System Supply Identifier | 205309 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68122","type":"LOCAL"},{"code":"205334","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68122 = Hospital System Supply Identifier | 205334 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68108","type":"LOCAL"},{"code":"205320","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68108 = Hospital System Supply Identifier | 205320 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68027","type":"LOCAL"},{"code":"205237","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68027 = Hospital System Supply Identifier | 205237 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65217","type":"LOCAL"},{"code":"146507","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65217 = Hospital System Supply Identifier | 146507 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65234","type":"LOCAL"},{"code":"146524","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65234 = Hospital System Supply Identifier | 146524 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65228","type":"LOCAL"},{"code":"146518","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65228 = Hospital System Supply Identifier | 146518 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65223","type":"LOCAL"},{"code":"146513","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65223 = Hospital System Supply Identifier | 146513 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X340MM","code_information":[{"code":"Sx00-2252-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65239","type":"LOCAL"},{"code":"146530","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65239 = Hospital System Supply Identifier | 146530 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"9511","type":"LOCAL"},{"code":"205335","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 9511 = Hospital System Supply Identifier | 205335 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68110","type":"LOCAL"},{"code":"205322","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68110 = Hospital System Supply Identifier | 205322 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68028","type":"LOCAL"},{"code":"205238","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68028 = Hospital System Supply Identifier | 205238 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65246","type":"LOCAL"},{"code":"146537","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65246 = Hospital System Supply Identifier | 146537 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65240","type":"LOCAL"},{"code":"146531","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65240 = Hospital System Supply Identifier | 146531 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65229","type":"LOCAL"},{"code":"146519","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65229 = Hospital System Supply Identifier | 146519 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65224","type":"LOCAL"},{"code":"146514","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65224 = Hospital System Supply Identifier | 146514 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65218","type":"LOCAL"},{"code":"146508","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65218 = Hospital System Supply Identifier | 146508 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X360MM","code_information":[{"code":"Sx00-2252-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65235","type":"LOCAL"},{"code":"146525","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65235 = Hospital System Supply Identifier | 146525 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68029","type":"LOCAL"},{"code":"205239","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68029 = Hospital System Supply Identifier | 205239 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68124","type":"LOCAL"},{"code":"205337","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68124 = Hospital System Supply Identifier | 205337 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68111","type":"LOCAL"},{"code":"205323","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68111 = Hospital System Supply Identifier | 205323 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65241","type":"LOCAL"},{"code":"146532","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65241 = Hospital System Supply Identifier | 146532 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65247","type":"LOCAL"},{"code":"146538","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65247 = Hospital System Supply Identifier | 146538 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65230","type":"LOCAL"},{"code":"146520","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65230 = Hospital System Supply Identifier | 146520 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65225","type":"LOCAL"},{"code":"146515","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65225 = Hospital System Supply Identifier | 146515 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65219","type":"LOCAL"},{"code":"146509","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65219 = Hospital System Supply Identifier | 146509 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X380MM","code_information":[{"code":"Sx00-2252-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53284","type":"LOCAL"},{"code":"146526","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53284 = Hospital System Supply Identifier | 146526 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65242","type":"LOCAL"},{"code":"146533","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65242 = Hospital System Supply Identifier | 146533 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65220","type":"LOCAL"},{"code":"146510","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65220 = Hospital System Supply Identifier | 146510 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65226","type":"LOCAL"},{"code":"146516","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65226 = Hospital System Supply Identifier | 146516 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65231","type":"LOCAL"},{"code":"146521","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65231 = Hospital System Supply Identifier | 146521 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65236","type":"LOCAL"},{"code":"146527","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65236 = Hospital System Supply Identifier | 146527 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65248","type":"LOCAL"},{"code":"146539","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65248 = Hospital System Supply Identifier | 146539 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68030","type":"LOCAL"},{"code":"205240","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68030 = Hospital System Supply Identifier | 205240 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68112","type":"LOCAL"},{"code":"205324","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68112 = Hospital System Supply Identifier | 205324 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X400MM","code_information":[{"code":"Sx00-2252-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68125","type":"LOCAL"},{"code":"205338","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68125 = Hospital System Supply Identifier | 205338 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68114","type":"LOCAL"},{"code":"205326","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68114 = Hospital System Supply Identifier | 205326 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68126","type":"LOCAL"},{"code":"205339","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68126 = Hospital System Supply Identifier | 205339 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65249","type":"LOCAL"},{"code":"146540","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65249 = Hospital System Supply Identifier | 146540 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65243","type":"LOCAL"},{"code":"146534","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65243 = Hospital System Supply Identifier | 146534 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68031","type":"LOCAL"},{"code":"205241","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68031 = Hospital System Supply Identifier | 205241 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65232","type":"LOCAL"},{"code":"146522","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65232 = Hospital System Supply Identifier | 146522 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65227","type":"LOCAL"},{"code":"146517","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65227 = Hospital System Supply Identifier | 146517 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65221","type":"LOCAL"},{"code":"146511","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65221 = Hospital System Supply Identifier | 146511 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X420MM","code_information":[{"code":"Sx00-2252-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65237","type":"LOCAL"},{"code":"146528","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65237 = Hospital System Supply Identifier | 146528 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68128","type":"LOCAL"},{"code":"205341","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68128 = Hospital System Supply Identifier | 205341 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68115","type":"LOCAL"},{"code":"205327","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68115 = Hospital System Supply Identifier | 205327 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68038","type":"LOCAL"},{"code":"205248","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68038 = Hospital System Supply Identifier | 205248 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 8X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68032","type":"LOCAL"},{"code":"205242","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68032 = Hospital System Supply Identifier | 205242 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68051","type":"LOCAL"},{"code":"205261","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68051 = Hospital System Supply Identifier | 205261 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65244","type":"LOCAL"},{"code":"146535","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65244 = Hospital System Supply Identifier | 146535 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65238","type":"LOCAL"},{"code":"146529","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65238 = Hospital System Supply Identifier | 146529 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65233","type":"LOCAL"},{"code":"146523","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65233 = Hospital System Supply Identifier | 146523 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X440MM","code_information":[{"code":"Sx00-2252-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65250","type":"LOCAL"},{"code":"146541","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65250 = Hospital System Supply Identifier | 146541 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68129","type":"LOCAL"},{"code":"205342","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68129 = Hospital System Supply Identifier | 205342 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65245","type":"LOCAL"},{"code":"146536","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65245 = Hospital System Supply Identifier | 146536 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65251","type":"LOCAL"},{"code":"146542","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65251 = Hospital System Supply Identifier | 146542 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 9X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68040","type":"LOCAL"},{"code":"205250","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68040 = Hospital System Supply Identifier | 205250 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68052","type":"LOCAL"},{"code":"205262","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68052 = Hospital System Supply Identifier | 205262 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68061","type":"LOCAL"},{"code":"205271","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68061 = Hospital System Supply Identifier | 205271 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68073","type":"LOCAL"},{"code":"205283","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68073 = Hospital System Supply Identifier | 205283 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X460MM","code_information":[{"code":"Sx00-2252-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68116","type":"LOCAL"},{"code":"205328","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68116 = Hospital System Supply Identifier | 205328 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68117","type":"LOCAL"},{"code":"205329","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68117 = Hospital System Supply Identifier | 205329 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 12X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68074","type":"LOCAL"},{"code":"205284","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68074 = Hospital System Supply Identifier | 205284 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68130","type":"LOCAL"},{"code":"205343","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68130 = Hospital System Supply Identifier | 205343 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68103","type":"LOCAL"},{"code":"205315","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68103 = Hospital System Supply Identifier | 205315 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 10X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68053","type":"LOCAL"},{"code":"205263","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68053 = Hospital System Supply Identifier | 205263 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 11X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68062","type":"LOCAL"},{"code":"205272","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68062 = Hospital System Supply Identifier | 205272 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X480MM","code_information":[{"code":"Sx00-2252-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68089","type":"LOCAL"},{"code":"205300","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68089 = Hospital System Supply Identifier | 205300 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 13X500MM","code_information":[{"code":"Sx00-2252-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68090","type":"LOCAL"},{"code":"205301","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68090 = Hospital System Supply Identifier | 205301 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 14X500MM","code_information":[{"code":"Sx00-2252-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68104","type":"LOCAL"},{"code":"205316","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68104 = Hospital System Supply Identifier | 205316 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 15X500MM","code_information":[{"code":"Sx00-2252-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68118","type":"LOCAL"},{"code":"205330","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68118 = Hospital System Supply Identifier | 205330 = Lawson ID"}]},{"description":"NAIL FEM SS M/DN 16X500MM","code_information":[{"code":"Sx00-2252-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68132","type":"LOCAL"},{"code":"205345","type":"LOCAL"}],"standard_charges":[{"gross_charge":2202.2,"discounted_cash":1541.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68132 = Hospital System Supply Identifier | 205345 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X20","code_information":[{"code":"Sx00-2253-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53285","type":"LOCAL"},{"code":"146575","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53285 = Hospital System Supply Identifier | 146575 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X20","code_information":[{"code":"Sx00-2253-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65296","type":"LOCAL"},{"code":"146590","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65296 = Hospital System Supply Identifier | 146590 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X20","code_information":[{"code":"Sx00-2253-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2353","type":"LOCAL"},{"code":"339933","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2353 = Hospital System Supply Identifier | 339933 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X20","code_information":[{"code":"Sx00-2253-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65311","type":"LOCAL"},{"code":"146605","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65311 = Hospital System Supply Identifier | 146605 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X22.5","code_information":[{"code":"Sx00-2253-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68386","type":"LOCAL"},{"code":"206919","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68386 = Hospital System Supply Identifier | 206919 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X22.5","code_information":[{"code":"Sx00-2253-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68399","type":"LOCAL"},{"code":"206933","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68399 = Hospital System Supply Identifier | 206933 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X22.5M","code_information":[{"code":"Sx00-2253-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384015","type":"LOCAL"},{"code":"407369","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384015 = Hospital System Supply Identifier | 407369 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X25","code_information":[{"code":"Sx00-2253-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2354","type":"LOCAL"},{"code":"339934","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2354 = Hospital System Supply Identifier | 339934 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X25","code_information":[{"code":"Sx00-2253-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65282","type":"LOCAL"},{"code":"146576","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65282 = Hospital System Supply Identifier | 146576 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X25","code_information":[{"code":"Sx00-2253-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65297","type":"LOCAL"},{"code":"146591","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65297 = Hospital System Supply Identifier | 146591 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X25","code_information":[{"code":"Sx00-2253-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65312","type":"LOCAL"},{"code":"146606","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65312 = Hospital System Supply Identifier | 146606 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X27.5M","code_information":[{"code":"Sx00-2253-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384016","type":"LOCAL"},{"code":"407370","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384016 = Hospital System Supply Identifier | 407370 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X27.5","code_information":[{"code":"Sx00-2253-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68400","type":"LOCAL"},{"code":"206934","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68400 = Hospital System Supply Identifier | 206934 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X27.5","code_information":[{"code":"Sx00-2253-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68407","type":"LOCAL"},{"code":"206941","type":"LOCAL"}],"standard_charges":[{"gross_charge":547.65,"discounted_cash":383.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68407 = Hospital System Supply Identifier | 206941 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X30","code_information":[{"code":"Sx00-2253-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65283","type":"LOCAL"},{"code":"146577","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65283 = Hospital System Supply Identifier | 146577 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X30","code_information":[{"code":"Sx00-2253-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65298","type":"LOCAL"},{"code":"146592","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65298 = Hospital System Supply Identifier | 146592 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X30","code_information":[{"code":"Sx00-2253-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65313","type":"LOCAL"},{"code":"146607","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65313 = Hospital System Supply Identifier | 146607 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X30","code_information":[{"code":"Sx00-2253-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2355","type":"LOCAL"},{"code":"339935","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2355 = Hospital System Supply Identifier | 339935 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X32.5","code_information":[{"code":"Sx00-2253-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68387","type":"LOCAL"},{"code":"206920","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68387 = Hospital System Supply Identifier | 206920 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X32.5","code_information":[{"code":"Sx00-2253-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68405","type":"LOCAL"},{"code":"206939","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68405 = Hospital System Supply Identifier | 206939 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X32.5M","code_information":[{"code":"Sx00-2253-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384017","type":"LOCAL"},{"code":"407371","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384017 = Hospital System Supply Identifier | 407371 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X35","code_information":[{"code":"Sx00-2253-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65284","type":"LOCAL"},{"code":"146578","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65284 = Hospital System Supply Identifier | 146578 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X35","code_information":[{"code":"Sx00-2253-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65299","type":"LOCAL"},{"code":"146593","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65299 = Hospital System Supply Identifier | 146593 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X35","code_information":[{"code":"Sx00-2253-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65314","type":"LOCAL"},{"code":"146608","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65314 = Hospital System Supply Identifier | 146608 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X35","code_information":[{"code":"Sx00-2253-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2356","type":"LOCAL"},{"code":"339936","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2356 = Hospital System Supply Identifier | 339936 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X37.5M","code_information":[{"code":"Sx00-2253-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384018","type":"LOCAL"},{"code":"407372","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384018 = Hospital System Supply Identifier | 407372 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X37.5","code_information":[{"code":"Sx00-2253-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68397","type":"LOCAL"},{"code":"206931","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68397 = Hospital System Supply Identifier | 206931 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X37.5","code_information":[{"code":"Sx00-2253-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68406","type":"LOCAL"},{"code":"206940","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68406 = Hospital System Supply Identifier | 206940 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X40","code_information":[{"code":"Sx00-2253-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65315","type":"LOCAL"},{"code":"146609","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65315 = Hospital System Supply Identifier | 146609 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X40","code_information":[{"code":"Sx00-2253-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2357","type":"LOCAL"},{"code":"339937","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2357 = Hospital System Supply Identifier | 339937 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X40","code_information":[{"code":"Sx00-2253-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65285","type":"LOCAL"},{"code":"146579","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65285 = Hospital System Supply Identifier | 146579 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X40","code_information":[{"code":"Sx00-2253-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65300","type":"LOCAL"},{"code":"146594","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65300 = Hospital System Supply Identifier | 146594 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X42.5M","code_information":[{"code":"Sx00-2253-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384019","type":"LOCAL"},{"code":"407373","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384019 = Hospital System Supply Identifier | 407373 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X42.5","code_information":[{"code":"Sx00-2253-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68398","type":"LOCAL"},{"code":"206932","type":"LOCAL"}],"standard_charges":[{"gross_charge":547.65,"discounted_cash":383.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68398 = Hospital System Supply Identifier | 206932 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X42.5","code_information":[{"code":"Sx00-2253-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68381","type":"LOCAL"},{"code":"206914","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68381 = Hospital System Supply Identifier | 206914 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X45","code_information":[{"code":"Sx00-2253-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65286","type":"LOCAL"},{"code":"146580","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65286 = Hospital System Supply Identifier | 146580 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X45","code_information":[{"code":"Sx00-2253-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65301","type":"LOCAL"},{"code":"146595","type":"LOCAL"}],"standard_charges":[{"gross_charge":547.65,"discounted_cash":383.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65301 = Hospital System Supply Identifier | 146595 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X45","code_information":[{"code":"Sx00-2253-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53286","type":"LOCAL"},{"code":"146610","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53286 = Hospital System Supply Identifier | 146610 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X45","code_information":[{"code":"Sx00-2253-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2358","type":"LOCAL"},{"code":"339938","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2358 = Hospital System Supply Identifier | 339938 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X47.5","code_information":[{"code":"Sx00-2253-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68382","type":"LOCAL"},{"code":"206915","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68382 = Hospital System Supply Identifier | 206915 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X47.5","code_information":[{"code":"Sx00-2253-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68388","type":"LOCAL"},{"code":"206921","type":"LOCAL"}],"standard_charges":[{"gross_charge":547.65,"discounted_cash":383.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68388 = Hospital System Supply Identifier | 206921 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X47.5M","code_information":[{"code":"Sx00-2253-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384020","type":"LOCAL"},{"code":"407374","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384020 = Hospital System Supply Identifier | 407374 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X50","code_information":[{"code":"Sx00-2253-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65287","type":"LOCAL"},{"code":"146581","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65287 = Hospital System Supply Identifier | 146581 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X50","code_information":[{"code":"Sx00-2253-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65302","type":"LOCAL"},{"code":"146596","type":"LOCAL"}],"standard_charges":[{"gross_charge":547.65,"discounted_cash":383.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65302 = Hospital System Supply Identifier | 146596 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X50","code_information":[{"code":"Sx00-2253-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65316","type":"LOCAL"},{"code":"146611","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65316 = Hospital System Supply Identifier | 146611 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X52.5M","code_information":[{"code":"Sx00-2253-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384021","type":"LOCAL"},{"code":"407375","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384021 = Hospital System Supply Identifier | 407375 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X52.5","code_information":[{"code":"Sx00-2253-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68383","type":"LOCAL"},{"code":"206916","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68383 = Hospital System Supply Identifier | 206916 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X52.5","code_information":[{"code":"Sx00-2253-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68389","type":"LOCAL"},{"code":"206922","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68389 = Hospital System Supply Identifier | 206922 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X55","code_information":[{"code":"Sx00-2253-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65288","type":"LOCAL"},{"code":"146582","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65288 = Hospital System Supply Identifier | 146582 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X55","code_information":[{"code":"Sx00-2253-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65303","type":"LOCAL"},{"code":"146597","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65303 = Hospital System Supply Identifier | 146597 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X55","code_information":[{"code":"Sx00-2253-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53287","type":"LOCAL"},{"code":"146612","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53287 = Hospital System Supply Identifier | 146612 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X55","code_information":[{"code":"Sx00-2253-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2359","type":"LOCAL"},{"code":"339939","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2359 = Hospital System Supply Identifier | 339939 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X57.5","code_information":[{"code":"Sx00-2253-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68384","type":"LOCAL"},{"code":"206917","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68384 = Hospital System Supply Identifier | 206917 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X57.5","code_information":[{"code":"Sx00-2253-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68390","type":"LOCAL"},{"code":"206923","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68390 = Hospital System Supply Identifier | 206923 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X57.5M","code_information":[{"code":"Sx00-2253-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384022","type":"LOCAL"},{"code":"407376","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384022 = Hospital System Supply Identifier | 407376 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X60","code_information":[{"code":"Sx00-2253-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2360","type":"LOCAL"},{"code":"339940","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2360 = Hospital System Supply Identifier | 339940 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X60","code_information":[{"code":"Sx00-2253-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65317","type":"LOCAL"},{"code":"146613","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65317 = Hospital System Supply Identifier | 146613 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X60","code_information":[{"code":"Sx00-2253-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65289","type":"LOCAL"},{"code":"146583","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65289 = Hospital System Supply Identifier | 146583 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X60","code_information":[{"code":"Sx00-2253-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65304","type":"LOCAL"},{"code":"146598","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65304 = Hospital System Supply Identifier | 146598 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X62.5","code_information":[{"code":"Sx00-2253-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68385","type":"LOCAL"},{"code":"206918","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68385 = Hospital System Supply Identifier | 206918 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X62.5","code_information":[{"code":"Sx00-2253-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68391","type":"LOCAL"},{"code":"206924","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68391 = Hospital System Supply Identifier | 206924 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X62.5M","code_information":[{"code":"Sx00-2253-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384023","type":"LOCAL"},{"code":"407377","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384023 = Hospital System Supply Identifier | 407377 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X65","code_information":[{"code":"Sx00-2253-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65290","type":"LOCAL"},{"code":"146584","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65290 = Hospital System Supply Identifier | 146584 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X65","code_information":[{"code":"Sx00-2253-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65305","type":"LOCAL"},{"code":"146599","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65305 = Hospital System Supply Identifier | 146599 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X65","code_information":[{"code":"Sx00-2253-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65318","type":"LOCAL"},{"code":"146614","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65318 = Hospital System Supply Identifier | 146614 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X65","code_information":[{"code":"Sx00-2253-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2361","type":"LOCAL"},{"code":"339941","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2361 = Hospital System Supply Identifier | 339941 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X67.5","code_information":[{"code":"Sx00-2253-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68401","type":"LOCAL"},{"code":"206935","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68401 = Hospital System Supply Identifier | 206935 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X67.5M","code_information":[{"code":"Sx00-2253-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384024","type":"LOCAL"},{"code":"407378","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384024 = Hospital System Supply Identifier | 407378 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X67.5","code_information":[{"code":"Sx00-2253-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68395","type":"LOCAL"},{"code":"206928","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68395 = Hospital System Supply Identifier | 206928 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X70","code_information":[{"code":"Sx00-2253-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65291","type":"LOCAL"},{"code":"146585","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65291 = Hospital System Supply Identifier | 146585 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X70","code_information":[{"code":"Sx00-2253-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65306","type":"LOCAL"},{"code":"146600","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65306 = Hospital System Supply Identifier | 146600 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X70","code_information":[{"code":"Sx00-2253-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65319","type":"LOCAL"},{"code":"146615","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65319 = Hospital System Supply Identifier | 146615 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X70","code_information":[{"code":"Sx00-2253-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2362","type":"LOCAL"},{"code":"339942","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2362 = Hospital System Supply Identifier | 339942 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X72.5","code_information":[{"code":"Sx00-2253-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68396","type":"LOCAL"},{"code":"206930","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68396 = Hospital System Supply Identifier | 206930 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X72.5","code_information":[{"code":"Sx00-2253-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68402","type":"LOCAL"},{"code":"206936","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68402 = Hospital System Supply Identifier | 206936 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X72.5M","code_information":[{"code":"Sx00-2253-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384025","type":"LOCAL"},{"code":"407379","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384025 = Hospital System Supply Identifier | 407379 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X75","code_information":[{"code":"Sx00-2253-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2363","type":"LOCAL"},{"code":"339943","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2363 = Hospital System Supply Identifier | 339943 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X75","code_information":[{"code":"Sx00-2253-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65320","type":"LOCAL"},{"code":"146616","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65320 = Hospital System Supply Identifier | 146616 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X75","code_information":[{"code":"Sx00-2253-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65292","type":"LOCAL"},{"code":"146586","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65292 = Hospital System Supply Identifier | 146586 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X75","code_information":[{"code":"Sx00-2253-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65307","type":"LOCAL"},{"code":"146601","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65307 = Hospital System Supply Identifier | 146601 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X77.5","code_information":[{"code":"Sx00-2253-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68257","type":"LOCAL"},{"code":"205483","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68257 = Hospital System Supply Identifier | 205483 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X77.5","code_information":[{"code":"Sx00-2253-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68392","type":"LOCAL"},{"code":"206925","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68392 = Hospital System Supply Identifier | 206925 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X77.5M","code_information":[{"code":"Sx00-2253-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384026","type":"LOCAL"},{"code":"407380","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384026 = Hospital System Supply Identifier | 407380 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X80","code_information":[{"code":"Sx00-2253-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65293","type":"LOCAL"},{"code":"146587","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65293 = Hospital System Supply Identifier | 146587 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X80","code_information":[{"code":"Sx00-2253-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65308","type":"LOCAL"},{"code":"146602","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65308 = Hospital System Supply Identifier | 146602 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X80","code_information":[{"code":"Sx00-2253-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65321","type":"LOCAL"},{"code":"146617","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65321 = Hospital System Supply Identifier | 146617 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X80","code_information":[{"code":"Sx00-2253-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2364","type":"LOCAL"},{"code":"339944","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2364 = Hospital System Supply Identifier | 339944 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X82.5M","code_information":[{"code":"Sx00-2253-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384027","type":"LOCAL"},{"code":"407381","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384027 = Hospital System Supply Identifier | 407381 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X82.5","code_information":[{"code":"Sx00-2253-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68403","type":"LOCAL"},{"code":"206937","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68403 = Hospital System Supply Identifier | 206937 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X82.5","code_information":[{"code":"Sx00-2253-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68393","type":"LOCAL"},{"code":"206926","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68393 = Hospital System Supply Identifier | 206926 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X85","code_information":[{"code":"Sx00-2253-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65294","type":"LOCAL"},{"code":"146588","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65294 = Hospital System Supply Identifier | 146588 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X85","code_information":[{"code":"Sx00-2253-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65309","type":"LOCAL"},{"code":"146603","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65309 = Hospital System Supply Identifier | 146603 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X85","code_information":[{"code":"Sx00-2253-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65322","type":"LOCAL"},{"code":"146618","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65322 = Hospital System Supply Identifier | 146618 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X85","code_information":[{"code":"Sx00-2253-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2365","type":"LOCAL"},{"code":"339945","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2365 = Hospital System Supply Identifier | 339945 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X87.5","code_information":[{"code":"Sx00-2253-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68394","type":"LOCAL"},{"code":"206927","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68394 = Hospital System Supply Identifier | 206927 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X87.5","code_information":[{"code":"Sx00-2253-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68404","type":"LOCAL"},{"code":"206938","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68404 = Hospital System Supply Identifier | 206938 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X87.5M","code_information":[{"code":"Sx00-2253-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384028","type":"LOCAL"},{"code":"407382","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384028 = Hospital System Supply Identifier | 407382 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.5X90","code_information":[{"code":"Sx00-2253-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2366","type":"LOCAL"},{"code":"339946","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2366 = Hospital System Supply Identifier | 339946 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X90","code_information":[{"code":"Sx00-2253-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65323","type":"LOCAL"},{"code":"146619","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65323 = Hospital System Supply Identifier | 146619 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 3.7X90","code_information":[{"code":"Sx00-2253-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65295","type":"LOCAL"},{"code":"146589","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65295 = Hospital System Supply Identifier | 146589 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 4.2X90","code_information":[{"code":"Sx00-2253-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65310","type":"LOCAL"},{"code":"146604","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65310 = Hospital System Supply Identifier | 146604 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X95","code_information":[{"code":"Sx00-2253-095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65324","type":"LOCAL"},{"code":"146620","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65324 = Hospital System Supply Identifier | 146620 = Lawson ID"}]},{"description":"SCREW IM M/DN INTLOK 5.5X100","code_information":[{"code":"Sx00-2253-100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65325","type":"LOCAL"},{"code":"146621","type":"LOCAL"}],"standard_charges":[{"gross_charge":712.25,"discounted_cash":498.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65325 = Hospital System Supply Identifier | 146621 = Lawson ID"}]},{"description":"NAIL TIB SS 9X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68312","type":"LOCAL"},{"code":"205569","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68312 = Hospital System Supply Identifier | 205569 = Lawson ID"}]},{"description":"NAIL TIB SS 7X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"67876","type":"LOCAL"},{"code":"203126","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 67876 = Hospital System Supply Identifier | 203126 = Lawson ID"}]},{"description":"NAIL TIB SS 10X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68141","type":"LOCAL"},{"code":"205354","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68141 = Hospital System Supply Identifier | 205354 = Lawson ID"}]},{"description":"NAIL TIB SS 11X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68152","type":"LOCAL"},{"code":"205365","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68152 = Hospital System Supply Identifier | 205365 = Lawson ID"}]},{"description":"NAIL TIB SS 6X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68298","type":"LOCAL"},{"code":"205528","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68298 = Hospital System Supply Identifier | 205528 = Lawson ID"}]},{"description":"NAIL TIB SS 8X180MM","code_information":[{"code":"Sx00-2253-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68304","type":"LOCAL"},{"code":"205536","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68304 = Hospital System Supply Identifier | 205536 = Lawson ID"}]},{"description":"NAIL TIB SS 8X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68305","type":"LOCAL"},{"code":"205537","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68305 = Hospital System Supply Identifier | 205537 = Lawson ID"}]},{"description":"NAIL TIB SS 6X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68299","type":"LOCAL"},{"code":"205529","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68299 = Hospital System Supply Identifier | 205529 = Lawson ID"}]},{"description":"NAIL TIB SS 7X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68280","type":"LOCAL"},{"code":"205509","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68280 = Hospital System Supply Identifier | 205509 = Lawson ID"}]},{"description":"NAIL TIB SS 9X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68313","type":"LOCAL"},{"code":"205570","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68313 = Hospital System Supply Identifier | 205570 = Lawson ID"}]},{"description":"NAIL TIB SS 11X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68153","type":"LOCAL"},{"code":"205366","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68153 = Hospital System Supply Identifier | 205366 = Lawson ID"}]},{"description":"NAIL TIB SS 10X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68143","type":"LOCAL"},{"code":"205356","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68143 = Hospital System Supply Identifier | 205356 = Lawson ID"}]},{"description":"NAIL TIB SS 12X200MM","code_information":[{"code":"Sx00-2253-200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68169","type":"LOCAL"},{"code":"205384","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68169 = Hospital System Supply Identifier | 205384 = Lawson ID"}]},{"description":"NAIL TIB SS 8X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68306","type":"LOCAL"},{"code":"205538","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68306 = Hospital System Supply Identifier | 205538 = Lawson ID"}]},{"description":"NAIL TIB SS 6X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68300","type":"LOCAL"},{"code":"205530","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68300 = Hospital System Supply Identifier | 205530 = Lawson ID"}]},{"description":"NAIL TIB SS 9X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68314","type":"LOCAL"},{"code":"205571","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68314 = Hospital System Supply Identifier | 205571 = Lawson ID"}]},{"description":"NAIL TIB SS 7X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68281","type":"LOCAL"},{"code":"205510","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68281 = Hospital System Supply Identifier | 205510 = Lawson ID"}]},{"description":"NAIL TIB SS 10X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68144","type":"LOCAL"},{"code":"205357","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68144 = Hospital System Supply Identifier | 205357 = Lawson ID"}]},{"description":"NAIL TIB SS 12X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68170","type":"LOCAL"},{"code":"205385","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68170 = Hospital System Supply Identifier | 205385 = Lawson ID"}]},{"description":"NAIL TIB SS 13X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68181","type":"LOCAL"},{"code":"205396","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68181 = Hospital System Supply Identifier | 205396 = Lawson ID"}]},{"description":"NAIL TIB SS 11X220MM","code_information":[{"code":"Sx00-2253-220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68154","type":"LOCAL"},{"code":"205367","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68154 = Hospital System Supply Identifier | 205367 = Lawson ID"}]},{"description":"NAIL TIB SS 10X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68145","type":"LOCAL"},{"code":"205358","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68145 = Hospital System Supply Identifier | 205358 = Lawson ID"}]},{"description":"NAIL TIB SS 11X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68159","type":"LOCAL"},{"code":"205372","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68159 = Hospital System Supply Identifier | 205372 = Lawson ID"}]},{"description":"NAIL TIB SS 12X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68172","type":"LOCAL"},{"code":"205387","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68172 = Hospital System Supply Identifier | 205387 = Lawson ID"}]},{"description":"NAIL TIB SS 13X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68182","type":"LOCAL"},{"code":"205397","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68182 = Hospital System Supply Identifier | 205397 = Lawson ID"}]},{"description":"NAIL TIB SS 14X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68189","type":"LOCAL"},{"code":"205404","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68189 = Hospital System Supply Identifier | 205404 = Lawson ID"}]},{"description":"NAIL TIB SS 15X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68200","type":"LOCAL"},{"code":"205415","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68200 = Hospital System Supply Identifier | 205415 = Lawson ID"}]},{"description":"NAIL TIB SS 7X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68282","type":"LOCAL"},{"code":"205511","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68282 = Hospital System Supply Identifier | 205511 = Lawson ID"}]},{"description":"NAIL TIB SS 6X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68301","type":"LOCAL"},{"code":"205531","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68301 = Hospital System Supply Identifier | 205531 = Lawson ID"}]},{"description":"NAIL TIB SS 8X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68307","type":"LOCAL"},{"code":"205539","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68307 = Hospital System Supply Identifier | 205539 = Lawson ID"}]},{"description":"NAIL TIB SS 9X240MM","code_information":[{"code":"Sx00-2253-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68308","type":"LOCAL"},{"code":"205540","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68308 = Hospital System Supply Identifier | 205540 = Lawson ID"}]},{"description":"NAIL TIB SS 15X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68201","type":"LOCAL"},{"code":"205416","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68201 = Hospital System Supply Identifier | 205416 = Lawson ID"}]},{"description":"NAIL TIB SS 8X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68309","type":"LOCAL"},{"code":"205541","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68309 = Hospital System Supply Identifier | 205541 = Lawson ID"}]},{"description":"NAIL TIB SS 9X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68303","type":"LOCAL"},{"code":"205535","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68303 = Hospital System Supply Identifier | 205535 = Lawson ID"}]},{"description":"NAIL TIB SS 7X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68283","type":"LOCAL"},{"code":"205512","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68283 = Hospital System Supply Identifier | 205512 = Lawson ID"}]},{"description":"NAIL TIB SS 14X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68190","type":"LOCAL"},{"code":"205405","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68190 = Hospital System Supply Identifier | 205405 = Lawson ID"}]},{"description":"NAIL TIB SS 12X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68173","type":"LOCAL"},{"code":"205388","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68173 = Hospital System Supply Identifier | 205388 = Lawson ID"}]},{"description":"NAIL TIB SS 11X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68160","type":"LOCAL"},{"code":"205373","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68160 = Hospital System Supply Identifier | 205373 = Lawson ID"}]},{"description":"NAIL TIB SS 10X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68146","type":"LOCAL"},{"code":"205359","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68146 = Hospital System Supply Identifier | 205359 = Lawson ID"}]},{"description":"NAIL TIB SS 6X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"67722","type":"LOCAL"},{"code":"162223","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 67722 = Hospital System Supply Identifier | 162223 = Lawson ID"}]},{"description":"NAIL TIB SS 13X260MM","code_information":[{"code":"Sx00-2253-260","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68183","type":"LOCAL"},{"code":"205398","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68183 = Hospital System Supply Identifier | 205398 = Lawson ID"}]},{"description":"NAIL TIB SS 12X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68175","type":"LOCAL"},{"code":"205390","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68175 = Hospital System Supply Identifier | 205390 = Lawson ID"}]},{"description":"NAIL TIB SS 8X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65252","type":"LOCAL"},{"code":"146543","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65252 = Hospital System Supply Identifier | 146543 = Lawson ID"}]},{"description":"NAIL TIB SS 9X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65258","type":"LOCAL"},{"code":"146549","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65258 = Hospital System Supply Identifier | 146549 = Lawson ID"}]},{"description":"NAIL TIB SS 10X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65263","type":"LOCAL"},{"code":"146554","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65263 = Hospital System Supply Identifier | 146554 = Lawson ID"}]},{"description":"NAIL TIB SS 11X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68161","type":"LOCAL"},{"code":"205374","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68161 = Hospital System Supply Identifier | 205374 = Lawson ID"}]},{"description":"NAIL TIB SS 13X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68184","type":"LOCAL"},{"code":"205399","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68184 = Hospital System Supply Identifier | 205399 = Lawson ID"}]},{"description":"NAIL TIB SS 14X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68191","type":"LOCAL"},{"code":"205406","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68191 = Hospital System Supply Identifier | 205406 = Lawson ID"}]},{"description":"NAIL TIB SS 15X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68202","type":"LOCAL"},{"code":"205417","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68202 = Hospital System Supply Identifier | 205417 = Lawson ID"}]},{"description":"NAIL TIB SS 7X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68284","type":"LOCAL"},{"code":"205513","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68284 = Hospital System Supply Identifier | 205513 = Lawson ID"}]},{"description":"NAIL TIB SS 6X280MM","code_information":[{"code":"Sx00-2253-280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68292","type":"LOCAL"},{"code":"205522","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68292 = Hospital System Supply Identifier | 205522 = Lawson ID"}]},{"description":"NAIL TIB SS 15X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68203","type":"LOCAL"},{"code":"205418","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68203 = Hospital System Supply Identifier | 205418 = Lawson ID"}]},{"description":"NAIL TIB SS 14X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68192","type":"LOCAL"},{"code":"205407","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68192 = Hospital System Supply Identifier | 205407 = Lawson ID"}]},{"description":"NAIL TIB SS 7X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68285","type":"LOCAL"},{"code":"205514","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68285 = Hospital System Supply Identifier | 205514 = Lawson ID"}]},{"description":"NAIL TIB SS 6X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68293","type":"LOCAL"},{"code":"205523","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68293 = Hospital System Supply Identifier | 205523 = Lawson ID"}]},{"description":"NAIL TIB SS 13X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65278","type":"LOCAL"},{"code":"146570","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65278 = Hospital System Supply Identifier | 146570 = Lawson ID"}]},{"description":"NAIL TIB SS 11X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65268","type":"LOCAL"},{"code":"146560","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65268 = Hospital System Supply Identifier | 146560 = Lawson ID"}]},{"description":"NAIL TIB SS 10X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65189","type":"LOCAL"},{"code":"145989","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65189 = Hospital System Supply Identifier | 145989 = Lawson ID"}]},{"description":"NAIL TIB SS 12X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65273","type":"LOCAL"},{"code":"146565","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65273 = Hospital System Supply Identifier | 146565 = Lawson ID"}]},{"description":"NAIL TIB SS 9X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65259","type":"LOCAL"},{"code":"146550","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65259 = Hospital System Supply Identifier | 146550 = Lawson ID"}]},{"description":"NAIL TIB SS 8X300MM","code_information":[{"code":"Sx00-2253-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65253","type":"LOCAL"},{"code":"146544","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65253 = Hospital System Supply Identifier | 146544 = Lawson ID"}]},{"description":"NAIL TIB SS 6X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68294","type":"LOCAL"},{"code":"205524","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68294 = Hospital System Supply Identifier | 205524 = Lawson ID"}]},{"description":"NAIL TIB SS 7X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68286","type":"LOCAL"},{"code":"205515","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68286 = Hospital System Supply Identifier | 205515 = Lawson ID"}]},{"description":"NAIL TIB SS 15X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68204","type":"LOCAL"},{"code":"205419","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68204 = Hospital System Supply Identifier | 205419 = Lawson ID"}]},{"description":"NAIL TIB SS 13X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65279","type":"LOCAL"},{"code":"146571","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65279 = Hospital System Supply Identifier | 146571 = Lawson ID"}]},{"description":"NAIL TIB SS 14X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68193","type":"LOCAL"},{"code":"205408","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68193 = Hospital System Supply Identifier | 205408 = Lawson ID"}]},{"description":"NAIL TIB SS 11X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65269","type":"LOCAL"},{"code":"146561","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65269 = Hospital System Supply Identifier | 146561 = Lawson ID"}]},{"description":"NAIL TIB SS 10X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65264","type":"LOCAL"},{"code":"146556","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65264 = Hospital System Supply Identifier | 146556 = Lawson ID"}]},{"description":"NAIL TIB SS 9X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65260","type":"LOCAL"},{"code":"146551","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65260 = Hospital System Supply Identifier | 146551 = Lawson ID"}]},{"description":"NAIL TIB SS 8X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65254","type":"LOCAL"},{"code":"146545","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65254 = Hospital System Supply Identifier | 146545 = Lawson ID"}]},{"description":"NAIL TIB SS 12X320MM","code_information":[{"code":"Sx00-2253-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65274","type":"LOCAL"},{"code":"146566","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65274 = Hospital System Supply Identifier | 146566 = Lawson ID"}]},{"description":"NAIL TIB SS 6X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68295","type":"LOCAL"},{"code":"205525","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68295 = Hospital System Supply Identifier | 205525 = Lawson ID"}]},{"description":"NAIL TIB SS 7X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68287","type":"LOCAL"},{"code":"205517","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68287 = Hospital System Supply Identifier | 205517 = Lawson ID"}]},{"description":"NAIL TIB SS 15X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68205","type":"LOCAL"},{"code":"205420","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68205 = Hospital System Supply Identifier | 205420 = Lawson ID"}]},{"description":"NAIL TIB SS 14X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68194","type":"LOCAL"},{"code":"205409","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68194 = Hospital System Supply Identifier | 205409 = Lawson ID"}]},{"description":"NAIL TIB SS 9X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65339","type":"LOCAL"},{"code":"148332","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65339 = Hospital System Supply Identifier | 148332 = Lawson ID"}]},{"description":"NAIL TIB SS 13X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65280","type":"LOCAL"},{"code":"146572","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65280 = Hospital System Supply Identifier | 146572 = Lawson ID"}]},{"description":"NAIL TIB SS 11X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65270","type":"LOCAL"},{"code":"146562","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65270 = Hospital System Supply Identifier | 146562 = Lawson ID"}]},{"description":"NAIL TIB SS 10X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65265","type":"LOCAL"},{"code":"146557","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65265 = Hospital System Supply Identifier | 146557 = Lawson ID"}]},{"description":"NAIL TIB SS 8X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65255","type":"LOCAL"},{"code":"146546","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65255 = Hospital System Supply Identifier | 146546 = Lawson ID"}]},{"description":"NAIL TIB SS 12X340MM","code_information":[{"code":"Sx00-2253-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65275","type":"LOCAL"},{"code":"146567","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65275 = Hospital System Supply Identifier | 146567 = Lawson ID"}]},{"description":"NAIL TIB SS 6X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68296","type":"LOCAL"},{"code":"205526","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68296 = Hospital System Supply Identifier | 205526 = Lawson ID"}]},{"description":"NAIL TIB SS 7X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68289","type":"LOCAL"},{"code":"205519","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68289 = Hospital System Supply Identifier | 205519 = Lawson ID"}]},{"description":"NAIL TIB SS 15X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53399","type":"LOCAL"},{"code":"205421","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53399 = Hospital System Supply Identifier | 205421 = Lawson ID"}]},{"description":"NAIL TIB SS 14X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68195","type":"LOCAL"},{"code":"205410","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68195 = Hospital System Supply Identifier | 205410 = Lawson ID"}]},{"description":"NAIL TIB SS 13X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"3595","type":"LOCAL"},{"code":"146573","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 3595 = Hospital System Supply Identifier | 146573 = Lawson ID"}]},{"description":"NAIL TIB SS 11X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65271","type":"LOCAL"},{"code":"146563","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65271 = Hospital System Supply Identifier | 146563 = Lawson ID"}]},{"description":"NAIL TIB SS 10X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65266","type":"LOCAL"},{"code":"146558","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65266 = Hospital System Supply Identifier | 146558 = Lawson ID"}]},{"description":"NAIL TIB SS 9X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65261","type":"LOCAL"},{"code":"146552","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65261 = Hospital System Supply Identifier | 146552 = Lawson ID"}]},{"description":"NAIL TIB SS 8X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65256","type":"LOCAL"},{"code":"146547","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65256 = Hospital System Supply Identifier | 146547 = Lawson ID"}]},{"description":"NAIL TIB SS 12X360MM","code_information":[{"code":"Sx00-2253-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65276","type":"LOCAL"},{"code":"146568","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65276 = Hospital System Supply Identifier | 146568 = Lawson ID"}]},{"description":"NAIL TIB SS 14X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68196","type":"LOCAL"},{"code":"205411","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68196 = Hospital System Supply Identifier | 205411 = Lawson ID"}]},{"description":"NAIL TIB SS 6X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68297","type":"LOCAL"},{"code":"205527","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68297 = Hospital System Supply Identifier | 205527 = Lawson ID"}]},{"description":"NAIL TIB SS 7X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68290","type":"LOCAL"},{"code":"205520","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68290 = Hospital System Supply Identifier | 205520 = Lawson ID"}]},{"description":"NAIL TIB SS 15X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68206","type":"LOCAL"},{"code":"205422","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68206 = Hospital System Supply Identifier | 205422 = Lawson ID"}]},{"description":"NAIL TIB SS 13X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65281","type":"LOCAL"},{"code":"146574","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65281 = Hospital System Supply Identifier | 146574 = Lawson ID"}]},{"description":"NAIL TIB SS 8X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65257","type":"LOCAL"},{"code":"146548","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65257 = Hospital System Supply Identifier | 146548 = Lawson ID"}]},{"description":"NAIL TIB SS 11X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65272","type":"LOCAL"},{"code":"146564","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65272 = Hospital System Supply Identifier | 146564 = Lawson ID"}]},{"description":"NAIL TIB SS 9X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65262","type":"LOCAL"},{"code":"146553","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65262 = Hospital System Supply Identifier | 146553 = Lawson ID"}]},{"description":"NAIL TIB SS 12X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65277","type":"LOCAL"},{"code":"146569","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65277 = Hospital System Supply Identifier | 146569 = Lawson ID"}]},{"description":"NAIL TIB SS 10X380MM","code_information":[{"code":"Sx00-2253-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"65267","type":"LOCAL"},{"code":"146559","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65267 = Hospital System Supply Identifier | 146559 = Lawson ID"}]},{"description":"NAIL TIB SS 9X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68139","type":"LOCAL"},{"code":"205352","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68139 = Hospital System Supply Identifier | 205352 = Lawson ID"}]},{"description":"NAIL TIB SS 10X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68149","type":"LOCAL"},{"code":"205362","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68149 = Hospital System Supply Identifier | 205362 = Lawson ID"}]},{"description":"NAIL TIB SS 11X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"9512","type":"LOCAL"},{"code":"205377","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 9512 = Hospital System Supply Identifier | 205377 = Lawson ID"}]},{"description":"NAIL TIB SS 12X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68177","type":"LOCAL"},{"code":"205392","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68177 = Hospital System Supply Identifier | 205392 = Lawson ID"}]},{"description":"NAIL TIB SS 13X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68185","type":"LOCAL"},{"code":"205400","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68185 = Hospital System Supply Identifier | 205400 = Lawson ID"}]},{"description":"NAIL TIB SS 14X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68197","type":"LOCAL"},{"code":"205412","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68197 = Hospital System Supply Identifier | 205412 = Lawson ID"}]},{"description":"NAIL TIB SS 15X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68207","type":"LOCAL"},{"code":"205423","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68207 = Hospital System Supply Identifier | 205423 = Lawson ID"}]},{"description":"NAIL TIB SS 7X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68291","type":"LOCAL"},{"code":"205521","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68291 = Hospital System Supply Identifier | 205521 = Lawson ID"}]},{"description":"NAIL TIB SS 8X400MM","code_information":[{"code":"Sx00-2253-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"53401","type":"LOCAL"},{"code":"205533","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53401 = Hospital System Supply Identifier | 205533 = Lawson ID"}]},{"description":"NAIL TIB SS 15X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68208","type":"LOCAL"},{"code":"205424","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68208 = Hospital System Supply Identifier | 205424 = Lawson ID"}]},{"description":"NAIL TIB SS 14X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68198","type":"LOCAL"},{"code":"205413","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68198 = Hospital System Supply Identifier | 205413 = Lawson ID"}]},{"description":"NAIL TIB SS 13X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68186","type":"LOCAL"},{"code":"205401","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68186 = Hospital System Supply Identifier | 205401 = Lawson ID"}]},{"description":"NAIL TIB SS 8X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68302","type":"LOCAL"},{"code":"205534","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68302 = Hospital System Supply Identifier | 205534 = Lawson ID"}]},{"description":"NAIL TIB SS 11X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68165","type":"LOCAL"},{"code":"205380","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68165 = Hospital System Supply Identifier | 205380 = Lawson ID"}]},{"description":"NAIL TIB SS 10X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68150","type":"LOCAL"},{"code":"205363","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68150 = Hospital System Supply Identifier | 205363 = Lawson ID"}]},{"description":"NAIL TIB SS 9X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68140","type":"LOCAL"},{"code":"205353","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68140 = Hospital System Supply Identifier | 205353 = Lawson ID"}]},{"description":"NAIL TIB SS 12X420MM","code_information":[{"code":"Sx00-2253-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68178","type":"LOCAL"},{"code":"205393","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68178 = Hospital System Supply Identifier | 205393 = Lawson ID"}]},{"description":"NAIL TIB SS 10X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68151","type":"LOCAL"},{"code":"205364","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68151 = Hospital System Supply Identifier | 205364 = Lawson ID"}]},{"description":"NAIL TIB SS 11X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68166","type":"LOCAL"},{"code":"205381","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68166 = Hospital System Supply Identifier | 205381 = Lawson ID"}]},{"description":"NAIL TIB SS 12X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68179","type":"LOCAL"},{"code":"205394","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68179 = Hospital System Supply Identifier | 205394 = Lawson ID"}]},{"description":"NAIL TIB SS 13X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68187","type":"LOCAL"},{"code":"205402","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68187 = Hospital System Supply Identifier | 205402 = Lawson ID"}]},{"description":"NAIL TIB SS 14X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68199","type":"LOCAL"},{"code":"205414","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68199 = Hospital System Supply Identifier | 205414 = Lawson ID"}]},{"description":"NAIL TIB SS 15X440MM","code_information":[{"code":"Sx00-2253-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68209","type":"LOCAL"},{"code":"205425","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68209 = Hospital System Supply Identifier | 205425 = Lawson ID"}]},{"description":"NAIL TIB SS 13X460MM","code_information":[{"code":"Sx00-2253-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68188","type":"LOCAL"},{"code":"205403","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68188 = Hospital System Supply Identifier | 205403 = Lawson ID"}]},{"description":"NAIL TIB SS 11X460MM","code_information":[{"code":"Sx00-2253-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68168","type":"LOCAL"},{"code":"205383","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68168 = Hospital System Supply Identifier | 205383 = Lawson ID"}]},{"description":"NAIL TIB SS 12X460MM","code_information":[{"code":"Sx00-2253-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68180","type":"LOCAL"},{"code":"205395","type":"LOCAL"}],"standard_charges":[{"gross_charge":2260.7,"discounted_cash":1582.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68180 = Hospital System Supply Identifier | 205395 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384585","type":"LOCAL"},{"code":"411619","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384585 = Hospital System Supply Identifier | 411619 = Lawson ID"}]},{"description":"NAIL HUM MD/N 7MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384586","type":"LOCAL"},{"code":"411620","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384586 = Hospital System Supply Identifier | 411620 = Lawson ID"}]},{"description":"NAIL HUM MD/N 9MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384587","type":"LOCAL"},{"code":"411621","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384587 = Hospital System Supply Identifier | 411621 = Lawson ID"}]},{"description":"NAIL HUM MD/N 10MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384588","type":"LOCAL"},{"code":"411622","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384588 = Hospital System Supply Identifier | 411622 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX180MM","code_information":[{"code":"Sx00-2254-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384589","type":"LOCAL"},{"code":"411623","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384589 = Hospital System Supply Identifier | 411623 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384594","type":"LOCAL"},{"code":"411628","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384594 = Hospital System Supply Identifier | 411628 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384596","type":"LOCAL"},{"code":"411630","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384596 = Hospital System Supply Identifier | 411630 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384595","type":"LOCAL"},{"code":"411629","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384595 = Hospital System Supply Identifier | 411629 = Lawson ID"}]},{"description":"NAIL HUM MD/N 10MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384593","type":"LOCAL"},{"code":"411627","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384593 = Hospital System Supply Identifier | 411627 = Lawson ID"}]},{"description":"NAIL HUM MD/N 9MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384592","type":"LOCAL"},{"code":"411626","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384592 = Hospital System Supply Identifier | 411626 = Lawson ID"}]},{"description":"NAIL HUM MD/N 7MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384591","type":"LOCAL"},{"code":"411625","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384591 = Hospital System Supply Identifier | 411625 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384590","type":"LOCAL"},{"code":"411624","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384590 = Hospital System Supply Identifier | 411624 = Lawson ID"}]},{"description":"NAIL HUM MD/N 8MMX195MM","code_information":[{"code":"Sx00-2254-195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384584","type":"LOCAL"},{"code":"411293","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384584 = Hospital System Supply Identifier | 411293 = Lawson ID"}]},{"description":"NAIL HUM SS 7X210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68260","type":"LOCAL"},{"code":"205488","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68260 = Hospital System Supply Identifier | 205488 = Lawson ID"}]},{"description":"NAIL HUM SS 8X210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68264","type":"LOCAL"},{"code":"205492","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68264 = Hospital System Supply Identifier | 205492 = Lawson ID"}]},{"description":"NAIL HUM SS 9X210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68269","type":"LOCAL"},{"code":"205497","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68269 = Hospital System Supply Identifier | 205497 = Lawson ID"}]},{"description":"NAIL HUM SS 10X210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68274","type":"LOCAL"},{"code":"205502","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68274 = Hospital System Supply Identifier | 205502 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384597","type":"LOCAL"},{"code":"411631","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384597 = Hospital System Supply Identifier | 411631 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384598","type":"LOCAL"},{"code":"411632","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384598 = Hospital System Supply Identifier | 411632 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384599","type":"LOCAL"},{"code":"411633","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384599 = Hospital System Supply Identifier | 411633 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX210MM","code_information":[{"code":"Sx00-2254-210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384600","type":"LOCAL"},{"code":"411634","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384600 = Hospital System Supply Identifier | 411634 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384604","type":"LOCAL"},{"code":"411638","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384604 = Hospital System Supply Identifier | 411638 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384603","type":"LOCAL"},{"code":"411637","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384603 = Hospital System Supply Identifier | 411637 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX255MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384601","type":"LOCAL"},{"code":"411635","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384601 = Hospital System Supply Identifier | 411635 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384602","type":"LOCAL"},{"code":"411636","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384602 = Hospital System Supply Identifier | 411636 = Lawson ID"}]},{"description":"NAIL HUM SS 9X225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68270","type":"LOCAL"},{"code":"205498","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68270 = Hospital System Supply Identifier | 205498 = Lawson ID"}]},{"description":"NAIL HUM SS 8X225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68265","type":"LOCAL"},{"code":"205493","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68265 = Hospital System Supply Identifier | 205493 = Lawson ID"}]},{"description":"NAIL HUM SS 7X225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68261","type":"LOCAL"},{"code":"205489","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68261 = Hospital System Supply Identifier | 205489 = Lawson ID"}]},{"description":"NAIL HUM SS 10X225MM","code_information":[{"code":"Sx00-2254-225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68275","type":"LOCAL"},{"code":"205503","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68275 = Hospital System Supply Identifier | 205503 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384608","type":"LOCAL"},{"code":"411642","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384608 = Hospital System Supply Identifier | 411642 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384607","type":"LOCAL"},{"code":"411641","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384607 = Hospital System Supply Identifier | 411641 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384605","type":"LOCAL"},{"code":"411639","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384605 = Hospital System Supply Identifier | 411639 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384606","type":"LOCAL"},{"code":"411640","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384606 = Hospital System Supply Identifier | 411640 = Lawson ID"}]},{"description":"NAIL HUM SS 9X240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68271","type":"LOCAL"},{"code":"205499","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68271 = Hospital System Supply Identifier | 205499 = Lawson ID"}]},{"description":"NAIL HUM SS 8X240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68266","type":"LOCAL"},{"code":"205494","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68266 = Hospital System Supply Identifier | 205494 = Lawson ID"}]},{"description":"NAIL HUM SS 7X240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68262","type":"LOCAL"},{"code":"205490","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68262 = Hospital System Supply Identifier | 205490 = Lawson ID"}]},{"description":"NAIL HUM SS 10X240MM","code_information":[{"code":"Sx00-2254-240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68276","type":"LOCAL"},{"code":"205504","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68276 = Hospital System Supply Identifier | 205504 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384609","type":"LOCAL"},{"code":"411644","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384609 = Hospital System Supply Identifier | 411644 = Lawson ID"}]},{"description":"NAIL HUM SS 10X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"67440","type":"LOCAL"},{"code":"152149","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 67440 = Hospital System Supply Identifier | 152149 = Lawson ID"}]},{"description":"NAIL HUM SS 7X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68263","type":"LOCAL"},{"code":"205491","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68263 = Hospital System Supply Identifier | 205491 = Lawson ID"}]},{"description":"NAIL HUM SS 8X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68267","type":"LOCAL"},{"code":"205495","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68267 = Hospital System Supply Identifier | 205495 = Lawson ID"}]},{"description":"NAIL HUM SS 9X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68272","type":"LOCAL"},{"code":"205500","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68272 = Hospital System Supply Identifier | 205500 = Lawson ID"}]},{"description":"NAIL HUM SS 11X255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383730","type":"LOCAL"},{"code":"401978","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383730 = Hospital System Supply Identifier | 401978 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX255MM","code_information":[{"code":"Sx00-2254-255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384610","type":"LOCAL"},{"code":"411645","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384610 = Hospital System Supply Identifier | 411645 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384613","type":"LOCAL"},{"code":"411648","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384613 = Hospital System Supply Identifier | 411648 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384614","type":"LOCAL"},{"code":"411649","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384614 = Hospital System Supply Identifier | 411649 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384611","type":"LOCAL"},{"code":"411646","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384611 = Hospital System Supply Identifier | 411646 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384612","type":"LOCAL"},{"code":"411647","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384612 = Hospital System Supply Identifier | 411647 = Lawson ID"}]},{"description":"NAIL HUM SS 10X270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68277","type":"LOCAL"},{"code":"205505","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68277 = Hospital System Supply Identifier | 205505 = Lawson ID"}]},{"description":"NAIL HUM SS 8X270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68268","type":"LOCAL"},{"code":"205496","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68268 = Hospital System Supply Identifier | 205496 = Lawson ID"}]},{"description":"NAIL HUM SS 7X270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2367","type":"LOCAL"},{"code":"339947","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2367 = Hospital System Supply Identifier | 339947 = Lawson ID"}]},{"description":"NAIL HUM SS 9X270MM","code_information":[{"code":"Sx00-2254-270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"68273","type":"LOCAL"},{"code":"205501","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 68273 = Hospital System Supply Identifier | 205501 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384622","type":"LOCAL"},{"code":"411657","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384622 = Hospital System Supply Identifier | 411657 = Lawson ID"}]},{"description":"NAIL HUM MD/N 11MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384620","type":"LOCAL"},{"code":"411655","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384620 = Hospital System Supply Identifier | 411655 = Lawson ID"}]},{"description":"NAIL HUM MD/N 10MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384619","type":"LOCAL"},{"code":"411654","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384619 = Hospital System Supply Identifier | 411654 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384621","type":"LOCAL"},{"code":"411656","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384621 = Hospital System Supply Identifier | 411656 = Lawson ID"}]},{"description":"NAIL HUM MD/N 8MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384617","type":"LOCAL"},{"code":"411652","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384617 = Hospital System Supply Identifier | 411652 = Lawson ID"}]},{"description":"NAIL HUM MD/N 7MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384616","type":"LOCAL"},{"code":"411651","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384616 = Hospital System Supply Identifier | 411651 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384615","type":"LOCAL"},{"code":"411650","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384615 = Hospital System Supply Identifier | 411650 = Lawson ID"}]},{"description":"NAIL HUM MD/N 9MMX285MM","code_information":[{"code":"Sx00-2254-285","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384618","type":"LOCAL"},{"code":"411653","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384618 = Hospital System Supply Identifier | 411653 = Lawson ID"}]},{"description":"NAIL HUM MD/N 13MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384629","type":"LOCAL"},{"code":"411664","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384629 = Hospital System Supply Identifier | 411664 = Lawson ID"}]},{"description":"NAIL HUM SS 11X300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"37220","type":"LOCAL"},{"code":"155950","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37220 = Hospital System Supply Identifier | 155950 = Lawson ID"}]},{"description":"NAIL HUM MD/N 6MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384623","type":"LOCAL"},{"code":"411658","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384623 = Hospital System Supply Identifier | 411658 = Lawson ID"}]},{"description":"NAIL HUM MD/N 7MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384624","type":"LOCAL"},{"code":"411659","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384624 = Hospital System Supply Identifier | 411659 = Lawson ID"}]},{"description":"NAIL HUM MD/N 8MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384625","type":"LOCAL"},{"code":"411660","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384625 = Hospital System Supply Identifier | 411660 = Lawson ID"}]},{"description":"NAIL HUM MD/N 9MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384626","type":"LOCAL"},{"code":"411661","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384626 = Hospital System Supply Identifier | 411661 = Lawson ID"}]},{"description":"NAIL HUM MD/N 10MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384627","type":"LOCAL"},{"code":"411662","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384627 = Hospital System Supply Identifier | 411662 = Lawson ID"}]},{"description":"NAIL HUM MD/N 12MMX300MM","code_information":[{"code":"Sx00-2254-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384628","type":"LOCAL"},{"code":"411663","type":"LOCAL"}],"standard_charges":[{"gross_charge":2985.84,"discounted_cash":2090.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384628 = Hospital System Supply Identifier | 411663 = Lawson ID"}]},{"description":"DISC - TROCAR DISTAL 5.0","code_information":[{"code":"Sx00-2255-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"133386","type":"LOCAL"},{"code":"147988","type":"LOCAL"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 133386 = Hospital System Supply Identifier | 147988 = Lawson ID"}]},{"description":"DISC - TROCAR DISTAL 3.2","code_information":[{"code":"Sx00-2255-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"383158","type":"LOCAL"},{"code":"147986","type":"LOCAL"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383158 = Hospital System Supply Identifier | 147986 = Lawson ID"}]},{"description":"DISC - TROCAR DISTAL 3.7","code_information":[{"code":"Sx00-2255-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"383159","type":"LOCAL"},{"code":"147987","type":"LOCAL"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":300.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383159 = Hospital System Supply Identifier | 147987 = Lawson ID"}]},{"description":"GUIDE PIN 2.4 SMOOTH","code_information":[{"code":"Sx00-2255-025","type":"CDM"},{"code":"272","type":"RC"},{"code":"133591","type":"LOCAL"},{"code":"155954","type":"LOCAL"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 133591 = Hospital System Supply Identifier | 155954 = Lawson ID"}]},{"description":"DISC - BIT DRILL RETRO-FEM M/DN 3.7MM","code_information":[{"code":"Sx00-2255-031","type":"CDM"},{"code":"272","type":"RC"},{"code":"26252","type":"LOCAL"},{"code":"303895","type":"LOCAL"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":354.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 26252 = Hospital System Supply Identifier | 303895 = Lawson ID"}]},{"description":"DISC - BIT DRILL TIB-HUM M/DN 3.7MM","code_information":[{"code":"Sx00-2255-032","type":"CDM"},{"code":"272","type":"RC"},{"code":"133385","type":"LOCAL"},{"code":"147985","type":"LOCAL"}],"standard_charges":[{"gross_charge":670.8,"discounted_cash":469.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 133385 = Hospital System Supply Identifier | 147985 = Lawson ID"}]},{"description":"DISC - BIT DRILL PILOT TIP DST 3.2MM","code_information":[{"code":"Sx00-2255-033","type":"CDM"},{"code":"272","type":"RC"},{"code":"133387","type":"LOCAL"},{"code":"147989","type":"LOCAL"}],"standard_charges":[{"gross_charge":491.4,"discounted_cash":343.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 133387 = Hospital System Supply Identifier | 147989 = Lawson ID"}]},{"description":"BIT DRILL PILOT TIP DST 3.7MM","code_information":[{"code":"Sx00-2255-033","type":"CDM"},{"code":"272","type":"RC"},{"code":"133388","type":"LOCAL"},{"code":"147990","type":"LOCAL"}],"standard_charges":[{"gross_charge":491.4,"discounted_cash":343.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 133388 = Hospital System Supply Identifier | 147990 = Lawson ID"}]},{"description":"DISC - BIT DRILL PILOT TIP DST 5.0MM","code_information":[{"code":"Sx00-2255-033","type":"CDM"},{"code":"272","type":"RC"},{"code":"133389","type":"LOCAL"},{"code":"147991","type":"LOCAL"}],"standard_charges":[{"gross_charge":491.4,"discounted_cash":343.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 133389 = Hospital System Supply Identifier | 147991 = Lawson ID"}]},{"description":"BOLT TIBIAL PROX LOCKING","code_information":[{"code":"Sx00-2255-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"26253","type":"LOCAL"},{"code":"303896","type":"LOCAL"}],"standard_charges":[{"gross_charge":1274.52,"discounted_cash":892.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 26253 = Hospital System Supply Identifier | 303896 = Lawson ID"}]},{"description":"DISC - BIT DRILL FEM LG M/DN 5.0MM","code_information":[{"code":"Sx00-2255-035","type":"CDM"},{"code":"272","type":"RC"},{"code":"133384","type":"LOCAL"},{"code":"147984","type":"LOCAL"}],"standard_charges":[{"gross_charge":725.4,"discounted_cash":507.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 133384 = Hospital System Supply Identifier | 147984 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 15X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"12188","type":"LOCAL"},{"code":"236820","type":"LOCAL"}],"standard_charges":[{"gross_charge":2119.92,"discounted_cash":1483.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12188 = Hospital System Supply Identifier | 236820 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1948","type":"LOCAL"},{"code":"339248","type":"LOCAL"}],"standard_charges":[{"gross_charge":2119.92,"discounted_cash":1483.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1948 = Hospital System Supply Identifier | 339248 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2371","type":"LOCAL"},{"code":"339950","type":"LOCAL"}],"standard_charges":[{"gross_charge":2119.92,"discounted_cash":1483.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2371 = Hospital System Supply Identifier | 339950 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2372","type":"LOCAL"},{"code":"339951","type":"LOCAL"}],"standard_charges":[{"gross_charge":2119.92,"discounted_cash":1483.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2372 = Hospital System Supply Identifier | 339951 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2373","type":"LOCAL"},{"code":"339952","type":"LOCAL"}],"standard_charges":[{"gross_charge":2119.92,"discounted_cash":1483.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2373 = Hospital System Supply Identifier | 339952 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X180MM UNIV","code_information":[{"code":"Sx00-2257-180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2376","type":"LOCAL"},{"code":"339953","type":"LOCAL"}],"standard_charges":[{"gross_charge":2119.92,"discounted_cash":1483.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2376 = Hospital System Supply Identifier | 339953 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X400MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2383","type":"LOCAL"},{"code":"339960","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2383 = Hospital System Supply Identifier | 339960 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X300MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2386","type":"LOCAL"},{"code":"339963","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2386 = Hospital System Supply Identifier | 339963 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X300MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2385","type":"LOCAL"},{"code":"339962","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2385 = Hospital System Supply Identifier | 339962 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X300MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2384","type":"LOCAL"},{"code":"339961","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2384 = Hospital System Supply Identifier | 339961 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X300MM RT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2382","type":"LOCAL"},{"code":"339959","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2382 = Hospital System Supply Identifier | 339959 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2380","type":"LOCAL"},{"code":"339957","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2380 = Hospital System Supply Identifier | 339957 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2379","type":"LOCAL"},{"code":"339956","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2379 = Hospital System Supply Identifier | 339956 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2377","type":"LOCAL"},{"code":"339954","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2377 = Hospital System Supply Identifier | 339954 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2381","type":"LOCAL"},{"code":"339958","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2381 = Hospital System Supply Identifier | 339958 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X300MM LT","code_information":[{"code":"Sx00-2257-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2378","type":"LOCAL"},{"code":"339955","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2378 = Hospital System Supply Identifier | 339955 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X320MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31835","type":"LOCAL"},{"code":"332572","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31835 = Hospital System Supply Identifier | 332572 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X420MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31836","type":"LOCAL"},{"code":"332573","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31836 = Hospital System Supply Identifier | 332573 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X320MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31837","type":"LOCAL"},{"code":"332574","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31837 = Hospital System Supply Identifier | 332574 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X320MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39115","type":"LOCAL"},{"code":"332575","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39115 = Hospital System Supply Identifier | 332575 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X320MM LT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39116","type":"LOCAL"},{"code":"332576","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39116 = Hospital System Supply Identifier | 332576 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39118","type":"LOCAL"},{"code":"332578","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39118 = Hospital System Supply Identifier | 332578 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39119","type":"LOCAL"},{"code":"332579","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39119 = Hospital System Supply Identifier | 332579 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39120","type":"LOCAL"},{"code":"332580","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39120 = Hospital System Supply Identifier | 332580 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39121","type":"LOCAL"},{"code":"332581","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39121 = Hospital System Supply Identifier | 332581 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X320MM RT","code_information":[{"code":"Sx00-2257-320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39117","type":"LOCAL"},{"code":"332577","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39117 = Hospital System Supply Identifier | 332577 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39131","type":"LOCAL"},{"code":"332591","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39131 = Hospital System Supply Identifier | 332591 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39127","type":"LOCAL"},{"code":"332587","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39127 = Hospital System Supply Identifier | 332587 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39130","type":"LOCAL"},{"code":"332590","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39130 = Hospital System Supply Identifier | 332590 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39129","type":"LOCAL"},{"code":"332589","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39129 = Hospital System Supply Identifier | 332589 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X340MM RT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39128","type":"LOCAL"},{"code":"332588","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39128 = Hospital System Supply Identifier | 332588 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39126","type":"LOCAL"},{"code":"332586","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39126 = Hospital System Supply Identifier | 332586 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39124","type":"LOCAL"},{"code":"332584","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39124 = Hospital System Supply Identifier | 332584 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39123","type":"LOCAL"},{"code":"332583","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39123 = Hospital System Supply Identifier | 332583 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39122","type":"LOCAL"},{"code":"332582","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39122 = Hospital System Supply Identifier | 332582 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X340MM LT","code_information":[{"code":"Sx00-2257-340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39125","type":"LOCAL"},{"code":"332585","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39125 = Hospital System Supply Identifier | 332585 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2390","type":"LOCAL"},{"code":"339967","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2390 = Hospital System Supply Identifier | 339967 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2389","type":"LOCAL"},{"code":"339966","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2389 = Hospital System Supply Identifier | 339966 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2388","type":"LOCAL"},{"code":"339965","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2388 = Hospital System Supply Identifier | 339965 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2387","type":"LOCAL"},{"code":"339964","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2387 = Hospital System Supply Identifier | 339964 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39137","type":"LOCAL"},{"code":"332597","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39137 = Hospital System Supply Identifier | 332597 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X360MM RT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39136","type":"LOCAL"},{"code":"332596","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39136 = Hospital System Supply Identifier | 332596 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39134","type":"LOCAL"},{"code":"332594","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39134 = Hospital System Supply Identifier | 332594 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39133","type":"LOCAL"},{"code":"332593","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39133 = Hospital System Supply Identifier | 332593 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39132","type":"LOCAL"},{"code":"332592","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39132 = Hospital System Supply Identifier | 332592 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X360MM LT","code_information":[{"code":"Sx00-2257-360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39135","type":"LOCAL"},{"code":"332595","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39135 = Hospital System Supply Identifier | 332595 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39144","type":"LOCAL"},{"code":"332604","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39144 = Hospital System Supply Identifier | 332604 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39146","type":"LOCAL"},{"code":"332606","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39146 = Hospital System Supply Identifier | 332606 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39145","type":"LOCAL"},{"code":"332605","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39145 = Hospital System Supply Identifier | 332605 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2391","type":"LOCAL"},{"code":"339968","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2391 = Hospital System Supply Identifier | 339968 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39143","type":"LOCAL"},{"code":"332603","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39143 = Hospital System Supply Identifier | 332603 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39141","type":"LOCAL"},{"code":"332601","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39141 = Hospital System Supply Identifier | 332601 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39138","type":"LOCAL"},{"code":"332598","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39138 = Hospital System Supply Identifier | 332598 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X380MM RT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39142","type":"LOCAL"},{"code":"332602","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39142 = Hospital System Supply Identifier | 332602 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39140","type":"LOCAL"},{"code":"332600","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39140 = Hospital System Supply Identifier | 332600 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X380MM LT","code_information":[{"code":"Sx00-2257-380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39139","type":"LOCAL"},{"code":"332599","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39139 = Hospital System Supply Identifier | 332599 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39147","type":"LOCAL"},{"code":"332607","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39147 = Hospital System Supply Identifier | 332607 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39148","type":"LOCAL"},{"code":"332608","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39148 = Hospital System Supply Identifier | 332608 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39149","type":"LOCAL"},{"code":"332609","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39149 = Hospital System Supply Identifier | 332609 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39150","type":"LOCAL"},{"code":"332610","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39150 = Hospital System Supply Identifier | 332610 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X400MM LT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39151","type":"LOCAL"},{"code":"332611","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39151 = Hospital System Supply Identifier | 332611 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39152","type":"LOCAL"},{"code":"332612","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39152 = Hospital System Supply Identifier | 332612 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39153","type":"LOCAL"},{"code":"332613","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39153 = Hospital System Supply Identifier | 332613 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39154","type":"LOCAL"},{"code":"332614","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39154 = Hospital System Supply Identifier | 332614 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39155","type":"LOCAL"},{"code":"332615","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39155 = Hospital System Supply Identifier | 332615 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X400MM RT","code_information":[{"code":"Sx00-2257-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2392","type":"LOCAL"},{"code":"339969","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2392 = Hospital System Supply Identifier | 339969 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2393","type":"LOCAL"},{"code":"339970","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2393 = Hospital System Supply Identifier | 339970 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39164","type":"LOCAL"},{"code":"332624","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39164 = Hospital System Supply Identifier | 332624 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39163","type":"LOCAL"},{"code":"332623","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39163 = Hospital System Supply Identifier | 332623 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39162","type":"LOCAL"},{"code":"332622","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39162 = Hospital System Supply Identifier | 332622 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39161","type":"LOCAL"},{"code":"332621","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39161 = Hospital System Supply Identifier | 332621 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39159","type":"LOCAL"},{"code":"332619","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39159 = Hospital System Supply Identifier | 332619 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39158","type":"LOCAL"},{"code":"332618","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39158 = Hospital System Supply Identifier | 332618 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39157","type":"LOCAL"},{"code":"332617","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39157 = Hospital System Supply Identifier | 332617 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X420MM LT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39156","type":"LOCAL"},{"code":"332616","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39156 = Hospital System Supply Identifier | 332616 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X420MM RT","code_information":[{"code":"Sx00-2257-420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39160","type":"LOCAL"},{"code":"332620","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39160 = Hospital System Supply Identifier | 332620 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2394","type":"LOCAL"},{"code":"339971","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2394 = Hospital System Supply Identifier | 339971 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39173","type":"LOCAL"},{"code":"332633","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39173 = Hospital System Supply Identifier | 332633 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39172","type":"LOCAL"},{"code":"332632","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39172 = Hospital System Supply Identifier | 332632 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39171","type":"LOCAL"},{"code":"332631","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39171 = Hospital System Supply Identifier | 332631 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X440MM RT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39170","type":"LOCAL"},{"code":"332630","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39170 = Hospital System Supply Identifier | 332630 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39169","type":"LOCAL"},{"code":"332629","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39169 = Hospital System Supply Identifier | 332629 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39167","type":"LOCAL"},{"code":"332627","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39167 = Hospital System Supply Identifier | 332627 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39166","type":"LOCAL"},{"code":"332626","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39166 = Hospital System Supply Identifier | 332626 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39165","type":"LOCAL"},{"code":"332625","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39165 = Hospital System Supply Identifier | 332625 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X440MM LT","code_information":[{"code":"Sx00-2257-440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39168","type":"LOCAL"},{"code":"332628","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39168 = Hospital System Supply Identifier | 332628 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39183","type":"LOCAL"},{"code":"332643","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39183 = Hospital System Supply Identifier | 332643 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39182","type":"LOCAL"},{"code":"332642","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39182 = Hospital System Supply Identifier | 332642 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39181","type":"LOCAL"},{"code":"332641","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39181 = Hospital System Supply Identifier | 332641 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39179","type":"LOCAL"},{"code":"332639","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39179 = Hospital System Supply Identifier | 332639 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X460MM RT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39180","type":"LOCAL"},{"code":"332640","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39180 = Hospital System Supply Identifier | 332640 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39177","type":"LOCAL"},{"code":"332637","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39177 = Hospital System Supply Identifier | 332637 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39174","type":"LOCAL"},{"code":"332634","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39174 = Hospital System Supply Identifier | 332634 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39178","type":"LOCAL"},{"code":"332638","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39178 = Hospital System Supply Identifier | 332638 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39176","type":"LOCAL"},{"code":"332636","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39176 = Hospital System Supply Identifier | 332636 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X460MM LT","code_information":[{"code":"Sx00-2257-460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39175","type":"LOCAL"},{"code":"332635","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39175 = Hospital System Supply Identifier | 332635 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39184","type":"LOCAL"},{"code":"332644","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39184 = Hospital System Supply Identifier | 332644 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39185","type":"LOCAL"},{"code":"332645","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39185 = Hospital System Supply Identifier | 332645 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39186","type":"LOCAL"},{"code":"332646","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39186 = Hospital System Supply Identifier | 332646 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39187","type":"LOCAL"},{"code":"332647","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39187 = Hospital System Supply Identifier | 332647 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X480MM LT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39188","type":"LOCAL"},{"code":"332648","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39188 = Hospital System Supply Identifier | 332648 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39189","type":"LOCAL"},{"code":"332649","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39189 = Hospital System Supply Identifier | 332649 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39190","type":"LOCAL"},{"code":"332650","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39190 = Hospital System Supply Identifier | 332650 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39191","type":"LOCAL"},{"code":"332651","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39191 = Hospital System Supply Identifier | 332651 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39192","type":"LOCAL"},{"code":"332652","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39192 = Hospital System Supply Identifier | 332652 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X480MM RT","code_information":[{"code":"Sx00-2257-480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39193","type":"LOCAL"},{"code":"332653","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39193 = Hospital System Supply Identifier | 332653 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39203","type":"LOCAL"},{"code":"332663","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39203 = Hospital System Supply Identifier | 332663 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39202","type":"LOCAL"},{"code":"332662","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39202 = Hospital System Supply Identifier | 332662 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39201","type":"LOCAL"},{"code":"332661","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39201 = Hospital System Supply Identifier | 332661 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39199","type":"LOCAL"},{"code":"332659","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39199 = Hospital System Supply Identifier | 332659 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X500MM RT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39200","type":"LOCAL"},{"code":"332660","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39200 = Hospital System Supply Identifier | 332660 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 13X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39197","type":"LOCAL"},{"code":"332657","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39197 = Hospital System Supply Identifier | 332657 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 10X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39194","type":"LOCAL"},{"code":"332654","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39194 = Hospital System Supply Identifier | 332654 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 14X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39198","type":"LOCAL"},{"code":"332658","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39198 = Hospital System Supply Identifier | 332658 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 12X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39196","type":"LOCAL"},{"code":"332656","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39196 = Hospital System Supply Identifier | 332656 = Lawson ID"}]},{"description":"NAIL TRCH ISIT 11X500MM LT","code_information":[{"code":"Sx00-2257-500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"39195","type":"LOCAL"},{"code":"332655","type":"LOCAL"}],"standard_charges":[{"gross_charge":3084.82,"discounted_cash":2159.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39195 = Hospital System Supply Identifier | 332655 = Lawson ID"}]},{"description":"DISC - BIT DRILL FEM ITST 5.0MM","code_information":[{"code":"Sx00-2258-069","type":"CDM"},{"code":"272","type":"RC"},{"code":"12191","type":"LOCAL"},{"code":"236823","type":"LOCAL"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12191 = Hospital System Supply Identifier | 236823 = Lawson ID"}]},{"description":"DISC - BIT DRILL FEM ITST 3.7MM","code_information":[{"code":"Sx00-2258-069","type":"CDM"},{"code":"272","type":"RC"},{"code":"12192","type":"LOCAL"},{"code":"236824","type":"LOCAL"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12192 = Hospital System Supply Identifier | 236824 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X120MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2397","type":"LOCAL"},{"code":"339974","type":"LOCAL"}],"standard_charges":[{"gross_charge":1392.29,"discounted_cash":974.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2397 = Hospital System Supply Identifier | 339974 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X115MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2396","type":"LOCAL"},{"code":"339973","type":"LOCAL"}],"standard_charges":[{"gross_charge":1392.29,"discounted_cash":974.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2396 = Hospital System Supply Identifier | 339973 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X110MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2395","type":"LOCAL"},{"code":"339972","type":"LOCAL"}],"standard_charges":[{"gross_charge":1392.29,"discounted_cash":974.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2395 = Hospital System Supply Identifier | 339972 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X105MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31851","type":"LOCAL"},{"code":"332682","type":"LOCAL"}],"standard_charges":[{"gross_charge":1392.29,"discounted_cash":974.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31851 = Hospital System Supply Identifier | 332682 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X95MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31850","type":"LOCAL"},{"code":"332681","type":"LOCAL"}],"standard_charges":[{"gross_charge":1392.29,"discounted_cash":974.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31850 = Hospital System Supply Identifier | 332681 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X80MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31848","type":"LOCAL"},{"code":"332679","type":"LOCAL"}],"standard_charges":[{"gross_charge":1392.29,"discounted_cash":974.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31848 = Hospital System Supply Identifier | 332679 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X75MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31847","type":"LOCAL"},{"code":"332678","type":"LOCAL"}],"standard_charges":[{"gross_charge":1392.29,"discounted_cash":974.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31847 = Hospital System Supply Identifier | 332678 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X90MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31820","type":"LOCAL"},{"code":"332557","type":"LOCAL"}],"standard_charges":[{"gross_charge":1392.29,"discounted_cash":974.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31820 = Hospital System Supply Identifier | 332557 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X100MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"12189","type":"LOCAL"},{"code":"236821","type":"LOCAL"}],"standard_charges":[{"gross_charge":1392.29,"discounted_cash":974.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12189 = Hospital System Supply Identifier | 236821 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X85MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31849","type":"LOCAL"},{"code":"332680","type":"LOCAL"}],"standard_charges":[{"gross_charge":1392.29,"discounted_cash":974.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31849 = Hospital System Supply Identifier | 332680 = Lawson ID"}]},{"description":"SCREW LAG ITST 11X70MM","code_information":[{"code":"Sx00-2259-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31846","type":"LOCAL"},{"code":"332677","type":"LOCAL"}],"standard_charges":[{"gross_charge":1392.29,"discounted_cash":974.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31846 = Hospital System Supply Identifier | 332677 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-15","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"60989","type":"LOCAL"},{"code":"332667","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 60989 = Hospital System Supply Identifier | 332667 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-20","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"60990","type":"LOCAL"},{"code":"332668","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 60990 = Hospital System Supply Identifier | 332668 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-10","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"60988","type":"LOCAL"},{"code":"332666","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 60988 = Hospital System Supply Identifier | 332666 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-00","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"60986","type":"LOCAL"},{"code":"332664","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 60986 = Hospital System Supply Identifier | 332664 = Lawson ID"}]},{"description":"CAP NAIL SLIDING 2259-007-05","code_information":[{"code":"Sx00-2259-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"60987","type":"LOCAL"},{"code":"332665","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 60987 = Hospital System Supply Identifier | 332665 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-00","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31838","type":"LOCAL"},{"code":"332669","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31838 = Hospital System Supply Identifier | 332669 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-10","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31839","type":"LOCAL"},{"code":"332670","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31839 = Hospital System Supply Identifier | 332670 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-15","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31840","type":"LOCAL"},{"code":"332671","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31840 = Hospital System Supply Identifier | 332671 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-05","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2398","type":"LOCAL"},{"code":"339975","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2398 = Hospital System Supply Identifier | 339975 = Lawson ID"}]},{"description":"CAP NAIL LOCKING 2259-008-20","code_information":[{"code":"Sx00-2259-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2399","type":"LOCAL"},{"code":"339976","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2399 = Hospital System Supply Identifier | 339976 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-20","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31845","type":"LOCAL"},{"code":"332676","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31845 = Hospital System Supply Identifier | 332676 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-10","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31843","type":"LOCAL"},{"code":"332674","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31843 = Hospital System Supply Identifier | 332674 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-15","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31844","type":"LOCAL"},{"code":"332675","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31844 = Hospital System Supply Identifier | 332675 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-00","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31841","type":"LOCAL"},{"code":"332672","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31841 = Hospital System Supply Identifier | 332672 = Lawson ID"}]},{"description":"CAP NAIL NEUTRAL 2259-009-05","code_information":[{"code":"Sx00-2259-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31842","type":"LOCAL"},{"code":"332673","type":"LOCAL"}],"standard_charges":[{"gross_charge":656.65,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31842 = Hospital System Supply Identifier | 332673 = Lawson ID"}]},{"description":"BIT SCREWDRIVER HEX HD 3.5MM","code_information":[{"code":"Sx00-2305-017","type":"CDM"},{"code":"272","type":"RC"},{"code":"383165","type":"LOCAL"},{"code":"160088","type":"LOCAL"}],"standard_charges":[{"gross_charge":305.5,"discounted_cash":213.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383165 = Hospital System Supply Identifier | 160088 = Lawson ID"}]},{"description":"NUT ECT 11 X 8 MM 2317-01","code_information":[{"code":"Sx00-2317-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"43260","type":"LOCAL"},{"code":"157809","type":"LOCAL"}],"standard_charges":[{"gross_charge":123.5,"discounted_cash":86.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 43260 = Hospital System Supply Identifier | 157809 = Lawson ID"}]},{"description":"TAP SURG PERIARTC Q/C 4 130X35","code_information":[{"code":"Sx00-2346-046","type":"CDM"},{"code":"272","type":"RC"},{"code":"23202","type":"LOCAL"},{"code":"245986","type":"LOCAL"}],"standard_charges":[{"gross_charge":341.25,"discounted_cash":238.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23202 = Hospital System Supply Identifier | 245986 = Lawson ID"}]},{"description":"PLATE PERI-ART 2347-12-04","code_information":[{"code":"Sx00-2347-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52784","type":"LOCAL"},{"code":"203545","type":"LOCAL"}],"standard_charges":[{"gross_charge":1956.24,"discounted_cash":1369.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52784 = Hospital System Supply Identifier | 203545 = Lawson ID"}]},{"description":"SCREW PERIRTC 16MM THRD 6.5X25","code_information":[{"code":"Sx00-2347-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"38904","type":"LOCAL"},{"code":"245983","type":"LOCAL"}],"standard_charges":[{"gross_charge":148.2,"discounted_cash":103.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 38904 = Hospital System Supply Identifier | 245983 = Lawson ID"}]},{"description":"PLATE HUM LAT DST 92MM 4H RT","code_information":[{"code":"Sx00-2348-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384390","type":"LOCAL"},{"code":"410416","type":"LOCAL"}],"standard_charges":[{"gross_charge":1956.24,"discounted_cash":1369.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384390 = Hospital System Supply Identifier | 410416 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 10H RT","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11258","type":"LOCAL"},{"code":"228837","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11258 = Hospital System Supply Identifier | 228837 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 2H RT","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11262","type":"LOCAL"},{"code":"228841","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11262 = Hospital System Supply Identifier | 228841 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 12H RT","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11256","type":"LOCAL"},{"code":"228835","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11256 = Hospital System Supply Identifier | 228835 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-05-4","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52883","type":"LOCAL"},{"code":"208696","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52883 = Hospital System Supply Identifier | 208696 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-05-8","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52885","type":"LOCAL"},{"code":"208698","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52885 = Hospital System Supply Identifier | 208698 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-05-6","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52884","type":"LOCAL"},{"code":"208697","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52884 = Hospital System Supply Identifier | 208697 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 14H RT","code_information":[{"code":"Sx00-2348-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11254","type":"LOCAL"},{"code":"228833","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11254 = Hospital System Supply Identifier | 228833 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-06-4","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52886","type":"LOCAL"},{"code":"208699","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52886 = Hospital System Supply Identifier | 208699 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-06-6","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52887","type":"LOCAL"},{"code":"208700","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52887 = Hospital System Supply Identifier | 208700 = Lawson ID"}]},{"description":"PLATE DORSAL HUMERAL 2348-06-8","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52888","type":"LOCAL"},{"code":"208701","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52888 = Hospital System Supply Identifier | 208701 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 14H LT","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11253","type":"LOCAL"},{"code":"228832","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11253 = Hospital System Supply Identifier | 228832 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 12H LT","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11255","type":"LOCAL"},{"code":"228834","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11255 = Hospital System Supply Identifier | 228834 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 10H LT","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11257","type":"LOCAL"},{"code":"228836","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11257 = Hospital System Supply Identifier | 228836 = Lawson ID"}]},{"description":"PLATE DST POS/LAT HUM 2H LT","code_information":[{"code":"Sx00-2348-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11261","type":"LOCAL"},{"code":"228840","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11261 = Hospital System Supply Identifier | 228840 = Lawson ID"}]},{"description":"PLATE HUMERAL 2348-07-12","code_information":[{"code":"Sx00-2348-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52827","type":"LOCAL"},{"code":"208163","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52827 = Hospital System Supply Identifier | 208163 = Lawson ID"}]},{"description":"PLATE HUMERAL 2348-07-14","code_information":[{"code":"Sx00-2348-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52828","type":"LOCAL"},{"code":"208164","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52828 = Hospital System Supply Identifier | 208164 = Lawson ID"}]},{"description":"PLATE HUMERAL DIST 2348-07-16","code_information":[{"code":"Sx00-2348-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52829","type":"LOCAL"},{"code":"208165","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52829 = Hospital System Supply Identifier | 208165 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 10H RT","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11252","type":"LOCAL"},{"code":"228831","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11252 = Hospital System Supply Identifier | 228831 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 14H RT","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11264","type":"LOCAL"},{"code":"228843","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11264 = Hospital System Supply Identifier | 228843 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 12H RT","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11250","type":"LOCAL"},{"code":"228829","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11250 = Hospital System Supply Identifier | 228829 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 2H RT","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11260","type":"LOCAL"},{"code":"228839","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11260 = Hospital System Supply Identifier | 228839 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-09-06","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52879","type":"LOCAL"},{"code":"208691","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52879 = Hospital System Supply Identifier | 208691 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-09-08","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52880","type":"LOCAL"},{"code":"208692","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52880 = Hospital System Supply Identifier | 208692 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-09-04","code_information":[{"code":"Sx00-2348-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52878","type":"LOCAL"},{"code":"208690","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52878 = Hospital System Supply Identifier | 208690 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 12H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11265","type":"LOCAL"},{"code":"228844","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11265 = Hospital System Supply Identifier | 228844 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-10-04","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52881","type":"LOCAL"},{"code":"208693","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52881 = Hospital System Supply Identifier | 208693 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 6H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"9572","type":"LOCAL"},{"code":"208694","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 9572 = Hospital System Supply Identifier | 208694 = Lawson ID"}]},{"description":"PLATE DORSAL ULNA 2348-10-08","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52882","type":"LOCAL"},{"code":"208695","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52882 = Hospital System Supply Identifier | 208695 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 10H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11251","type":"LOCAL"},{"code":"228830","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11251 = Hospital System Supply Identifier | 228830 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 2H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11259","type":"LOCAL"},{"code":"228838","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11259 = Hospital System Supply Identifier | 228838 = Lawson ID"}]},{"description":"PLATE PROX DRSL ULNAR 14H LT","code_information":[{"code":"Sx00-2348-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"11263","type":"LOCAL"},{"code":"228842","type":"LOCAL"}],"standard_charges":[{"gross_charge":2288.91,"discounted_cash":1602.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11263 = Hospital System Supply Identifier | 228842 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-12","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52836","type":"LOCAL"},{"code":"208172","type":"LOCAL"}],"standard_charges":[{"gross_charge":1956.24,"discounted_cash":1369.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52836 = Hospital System Supply Identifier | 208172 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-10","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52835","type":"LOCAL"},{"code":"208171","type":"LOCAL"}],"standard_charges":[{"gross_charge":1843.38,"discounted_cash":1290.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52835 = Hospital System Supply Identifier | 208171 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-08","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52834","type":"LOCAL"},{"code":"208170","type":"LOCAL"}],"standard_charges":[{"gross_charge":1749.33,"discounted_cash":1224.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52834 = Hospital System Supply Identifier | 208170 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-02","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52830","type":"LOCAL"},{"code":"208166","type":"LOCAL"}],"standard_charges":[{"gross_charge":1627.46,"discounted_cash":1139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52830 = Hospital System Supply Identifier | 208166 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-04","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52832","type":"LOCAL"},{"code":"208168","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.28,"discounted_cash":1180.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52832 = Hospital System Supply Identifier | 208168 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-03","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52831","type":"LOCAL"},{"code":"208167","type":"LOCAL"}],"standard_charges":[{"gross_charge":1627.46,"discounted_cash":1139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52831 = Hospital System Supply Identifier | 208167 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-13-06","code_information":[{"code":"Sx00-2348-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52833","type":"LOCAL"},{"code":"208169","type":"LOCAL"}],"standard_charges":[{"gross_charge":1683.49,"discounted_cash":1178.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52833 = Hospital System Supply Identifier | 208169 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-08","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52841","type":"LOCAL"},{"code":"208177","type":"LOCAL"}],"standard_charges":[{"gross_charge":1749.33,"discounted_cash":1224.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52841 = Hospital System Supply Identifier | 208177 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-10","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52842","type":"LOCAL"},{"code":"208178","type":"LOCAL"}],"standard_charges":[{"gross_charge":1843.38,"discounted_cash":1290.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52842 = Hospital System Supply Identifier | 208178 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-12","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52843","type":"LOCAL"},{"code":"208179","type":"LOCAL"}],"standard_charges":[{"gross_charge":1956.24,"discounted_cash":1369.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52843 = Hospital System Supply Identifier | 208179 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-06","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52840","type":"LOCAL"},{"code":"208176","type":"LOCAL"}],"standard_charges":[{"gross_charge":1683.49,"discounted_cash":1178.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52840 = Hospital System Supply Identifier | 208176 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-03","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52838","type":"LOCAL"},{"code":"208174","type":"LOCAL"}],"standard_charges":[{"gross_charge":1627.46,"discounted_cash":1139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52838 = Hospital System Supply Identifier | 208174 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-02","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52837","type":"LOCAL"},{"code":"208173","type":"LOCAL"}],"standard_charges":[{"gross_charge":1627.46,"discounted_cash":1139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52837 = Hospital System Supply Identifier | 208173 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-14-04","code_information":[{"code":"Sx00-2348-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52839","type":"LOCAL"},{"code":"208175","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.28,"discounted_cash":1180.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52839 = Hospital System Supply Identifier | 208175 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-17-02","code_information":[{"code":"Sx00-2348-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52844","type":"LOCAL"},{"code":"208180","type":"LOCAL"}],"standard_charges":[{"gross_charge":1627.46,"discounted_cash":1139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52844 = Hospital System Supply Identifier | 208180 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-17-03","code_information":[{"code":"Sx00-2348-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52845","type":"LOCAL"},{"code":"208181","type":"LOCAL"}],"standard_charges":[{"gross_charge":1627.46,"discounted_cash":1139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52845 = Hospital System Supply Identifier | 208181 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-17-05","code_information":[{"code":"Sx00-2348-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52846","type":"LOCAL"},{"code":"208182","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.28,"discounted_cash":1180.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52846 = Hospital System Supply Identifier | 208182 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-17-07","code_information":[{"code":"Sx00-2348-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52847","type":"LOCAL"},{"code":"208183","type":"LOCAL"}],"standard_charges":[{"gross_charge":1683.49,"discounted_cash":1178.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52847 = Hospital System Supply Identifier | 208183 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-18-05","code_information":[{"code":"Sx00-2348-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52850","type":"LOCAL"},{"code":"208186","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.28,"discounted_cash":1180.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52850 = Hospital System Supply Identifier | 208186 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-18-07","code_information":[{"code":"Sx00-2348-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52851","type":"LOCAL"},{"code":"208187","type":"LOCAL"}],"standard_charges":[{"gross_charge":1683.49,"discounted_cash":1178.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52851 = Hospital System Supply Identifier | 208187 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-18-02","code_information":[{"code":"Sx00-2348-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52848","type":"LOCAL"},{"code":"208184","type":"LOCAL"}],"standard_charges":[{"gross_charge":1627.46,"discounted_cash":1139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52848 = Hospital System Supply Identifier | 208184 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-18-03","code_information":[{"code":"Sx00-2348-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52849","type":"LOCAL"},{"code":"208185","type":"LOCAL"}],"standard_charges":[{"gross_charge":1627.46,"discounted_cash":1139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52849 = Hospital System Supply Identifier | 208185 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-02","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52871","type":"LOCAL"},{"code":"208207","type":"LOCAL"}],"standard_charges":[{"gross_charge":1627.46,"discounted_cash":1139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52871 = Hospital System Supply Identifier | 208207 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-03","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52872","type":"LOCAL"},{"code":"208208","type":"LOCAL"}],"standard_charges":[{"gross_charge":1627.46,"discounted_cash":1139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52872 = Hospital System Supply Identifier | 208208 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-04","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52873","type":"LOCAL"},{"code":"208209","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.28,"discounted_cash":1180.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52873 = Hospital System Supply Identifier | 208209 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-06","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52874","type":"LOCAL"},{"code":"208210","type":"LOCAL"}],"standard_charges":[{"gross_charge":1683.49,"discounted_cash":1178.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52874 = Hospital System Supply Identifier | 208210 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-08","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52875","type":"LOCAL"},{"code":"208211","type":"LOCAL"}],"standard_charges":[{"gross_charge":1749.33,"discounted_cash":1224.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52875 = Hospital System Supply Identifier | 208211 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-10","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52876","type":"LOCAL"},{"code":"208212","type":"LOCAL"}],"standard_charges":[{"gross_charge":1843.38,"discounted_cash":1290.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52876 = Hospital System Supply Identifier | 208212 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-21-12","code_information":[{"code":"Sx00-2348-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52877","type":"LOCAL"},{"code":"208213","type":"LOCAL"}],"standard_charges":[{"gross_charge":1956.24,"discounted_cash":1369.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52877 = Hospital System Supply Identifier | 208213 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-10","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52869","type":"LOCAL"},{"code":"208205","type":"LOCAL"}],"standard_charges":[{"gross_charge":1843.38,"discounted_cash":1290.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52869 = Hospital System Supply Identifier | 208205 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-12","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52870","type":"LOCAL"},{"code":"208206","type":"LOCAL"}],"standard_charges":[{"gross_charge":1956.24,"discounted_cash":1369.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52870 = Hospital System Supply Identifier | 208206 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-08","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52868","type":"LOCAL"},{"code":"208204","type":"LOCAL"}],"standard_charges":[{"gross_charge":1749.33,"discounted_cash":1224.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52868 = Hospital System Supply Identifier | 208204 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-06","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52867","type":"LOCAL"},{"code":"208203","type":"LOCAL"}],"standard_charges":[{"gross_charge":1683.49,"discounted_cash":1178.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52867 = Hospital System Supply Identifier | 208203 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-04","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52866","type":"LOCAL"},{"code":"208202","type":"LOCAL"}],"standard_charges":[{"gross_charge":1686.28,"discounted_cash":1180.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52866 = Hospital System Supply Identifier | 208202 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-03","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52865","type":"LOCAL"},{"code":"208201","type":"LOCAL"}],"standard_charges":[{"gross_charge":1627.46,"discounted_cash":1139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52865 = Hospital System Supply Identifier | 208201 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-22-02","code_information":[{"code":"Sx00-2348-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52864","type":"LOCAL"},{"code":"208200","type":"LOCAL"}],"standard_charges":[{"gross_charge":1627.46,"discounted_cash":1139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52864 = Hospital System Supply Identifier | 208200 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-08","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52862","type":"LOCAL"},{"code":"208198","type":"LOCAL"}],"standard_charges":[{"gross_charge":2478.09,"discounted_cash":1734.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52862 = Hospital System Supply Identifier | 208198 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-06","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52861","type":"LOCAL"},{"code":"208197","type":"LOCAL"}],"standard_charges":[{"gross_charge":2353.61,"discounted_cash":1647.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52861 = Hospital System Supply Identifier | 208197 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-10","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52863","type":"LOCAL"},{"code":"208199","type":"LOCAL"}],"standard_charges":[{"gross_charge":2615.64,"discounted_cash":1830.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52863 = Hospital System Supply Identifier | 208199 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-02","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52859","type":"LOCAL"},{"code":"208195","type":"LOCAL"}],"standard_charges":[{"gross_charge":2153.25,"discounted_cash":1507.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52859 = Hospital System Supply Identifier | 208195 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-01","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52858","type":"LOCAL"},{"code":"208194","type":"LOCAL"}],"standard_charges":[{"gross_charge":2153.25,"discounted_cash":1507.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52858 = Hospital System Supply Identifier | 208194 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-25-04","code_information":[{"code":"Sx00-2348-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52860","type":"LOCAL"},{"code":"208196","type":"LOCAL"}],"standard_charges":[{"gross_charge":2248.57,"discounted_cash":1574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52860 = Hospital System Supply Identifier | 208196 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-26-01","code_information":[{"code":"Sx00-2348-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52852","type":"LOCAL"},{"code":"208188","type":"LOCAL"}],"standard_charges":[{"gross_charge":2153.25,"discounted_cash":1507.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52852 = Hospital System Supply Identifier | 208188 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-26-02","code_information":[{"code":"Sx00-2348-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52853","type":"LOCAL"},{"code":"208189","type":"LOCAL"}],"standard_charges":[{"gross_charge":2153.25,"discounted_cash":1507.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52853 = Hospital System Supply Identifier | 208189 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-26-04","code_information":[{"code":"Sx00-2348-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52854","type":"LOCAL"},{"code":"208190","type":"LOCAL"}],"standard_charges":[{"gross_charge":2248.57,"discounted_cash":1574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52854 = Hospital System Supply Identifier | 208190 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-26-06","code_information":[{"code":"Sx00-2348-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52855","type":"LOCAL"},{"code":"208191","type":"LOCAL"}],"standard_charges":[{"gross_charge":2353.61,"discounted_cash":1647.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52855 = Hospital System Supply Identifier | 208191 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-26-08","code_information":[{"code":"Sx00-2348-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52856","type":"LOCAL"},{"code":"208192","type":"LOCAL"}],"standard_charges":[{"gross_charge":2478.09,"discounted_cash":1734.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52856 = Hospital System Supply Identifier | 208192 = Lawson ID"}]},{"description":"PLATE RADIAL DIST 2348-26-10","code_information":[{"code":"Sx00-2348-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"52857","type":"LOCAL"},{"code":"208193","type":"LOCAL"}],"standard_charges":[{"gross_charge":2615.64,"discounted_cash":1830.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 52857 = Hospital System Supply Identifier | 208193 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 98MM 5H RT","code_information":[{"code":"Sx00-2358-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384408","type":"LOCAL"},{"code":"410434","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384408 = Hospital System Supply Identifier | 410434 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 150MM 9H RT","code_information":[{"code":"Sx00-2358-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384409","type":"LOCAL"},{"code":"410435","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384409 = Hospital System Supply Identifier | 410435 = Lawson ID"}]},{"description":"PLATE HUM DIST LOK LT 9H 150","code_information":[{"code":"Sx00-2358-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384895","type":"LOCAL"},{"code":"479626","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384895 = Hospital System Supply Identifier | 479626 = Lawson ID"}]},{"description":"PLATE LAT LOK DST HUM 5H LT","code_information":[{"code":"Sx00-2358-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383574","type":"LOCAL"},{"code":"395448","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383574 = Hospital System Supply Identifier | 395448 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 3H RT NS","code_information":[{"code":"Sx00-2358-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384410","type":"LOCAL"},{"code":"410436","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384410 = Hospital System Supply Identifier | 410436 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 78MM 3H LT","code_information":[{"code":"Sx00-2358-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384411","type":"LOCAL"},{"code":"410437","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384411 = Hospital System Supply Identifier | 410437 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 104MM 5H LT","code_information":[{"code":"Sx00-2358-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384412","type":"LOCAL"},{"code":"410438","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384412 = Hospital System Supply Identifier | 410438 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 130MM 7H LT","code_information":[{"code":"Sx00-2358-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384413","type":"LOCAL"},{"code":"410439","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384413 = Hospital System Supply Identifier | 410439 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 3H RT","code_information":[{"code":"Sx00-2358-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383367","type":"LOCAL"},{"code":"392693","type":"LOCAL"}],"standard_charges":[{"gross_charge":2272.88,"discounted_cash":1591.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383367 = Hospital System Supply Identifier | 392693 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 5H RT","code_information":[{"code":"Sx00-2358-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384770","type":"LOCAL"},{"code":"433869","type":"LOCAL"}],"standard_charges":[{"gross_charge":2272.88,"discounted_cash":1591.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384770 = Hospital System Supply Identifier | 433869 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 5H LT","code_information":[{"code":"Sx00-2358-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383330","type":"LOCAL"},{"code":"379064","type":"LOCAL"}],"standard_charges":[{"gross_charge":2272.88,"discounted_cash":1591.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383330 = Hospital System Supply Identifier | 379064 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 3H LT","code_information":[{"code":"Sx00-2358-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383575","type":"LOCAL"},{"code":"395449","type":"LOCAL"}],"standard_charges":[{"gross_charge":2272.88,"discounted_cash":1591.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383575 = Hospital System Supply Identifier | 395449 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 2H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24018","type":"LOCAL"},{"code":"257689","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24018 = Hospital System Supply Identifier | 257689 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 3H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24019","type":"LOCAL"},{"code":"257690","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24019 = Hospital System Supply Identifier | 257690 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 4H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24020","type":"LOCAL"},{"code":"257691","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24020 = Hospital System Supply Identifier | 257691 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 6H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24021","type":"LOCAL"},{"code":"257692","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24021 = Hospital System Supply Identifier | 257692 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 8H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24042","type":"LOCAL"},{"code":"257713","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24042 = Hospital System Supply Identifier | 257713 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 10H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24043","type":"LOCAL"},{"code":"257714","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24043 = Hospital System Supply Identifier | 257714 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 12H RT","code_information":[{"code":"Sx00-2358-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24044","type":"LOCAL"},{"code":"257715","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24044 = Hospital System Supply Identifier | 257715 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 8H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24045","type":"LOCAL"},{"code":"257716","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24045 = Hospital System Supply Identifier | 257716 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 12H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24047","type":"LOCAL"},{"code":"257718","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24047 = Hospital System Supply Identifier | 257718 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 6H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24025","type":"LOCAL"},{"code":"257696","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24025 = Hospital System Supply Identifier | 257696 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 10H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24046","type":"LOCAL"},{"code":"257717","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24046 = Hospital System Supply Identifier | 257717 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 3H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24023","type":"LOCAL"},{"code":"257694","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24023 = Hospital System Supply Identifier | 257694 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 2H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24022","type":"LOCAL"},{"code":"257693","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24022 = Hospital System Supply Identifier | 257693 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR RAD 4H LT","code_information":[{"code":"Sx00-2358-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24024","type":"LOCAL"},{"code":"257695","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24024 = Hospital System Supply Identifier | 257695 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 2H RT","code_information":[{"code":"Sx00-2358-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24026","type":"LOCAL"},{"code":"257697","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24026 = Hospital System Supply Identifier | 257697 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 3H RT","code_information":[{"code":"Sx00-2358-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24027","type":"LOCAL"},{"code":"257698","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24027 = Hospital System Supply Identifier | 257698 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 4H RT","code_information":[{"code":"Sx00-2358-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24028","type":"LOCAL"},{"code":"257699","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24028 = Hospital System Supply Identifier | 257699 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 6H RT","code_information":[{"code":"Sx00-2358-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24029","type":"LOCAL"},{"code":"257700","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24029 = Hospital System Supply Identifier | 257700 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 2H LT","code_information":[{"code":"Sx00-2358-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24030","type":"LOCAL"},{"code":"257701","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24030 = Hospital System Supply Identifier | 257701 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 3H LT","code_information":[{"code":"Sx00-2358-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24031","type":"LOCAL"},{"code":"257702","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24031 = Hospital System Supply Identifier | 257702 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 6H LT","code_information":[{"code":"Sx00-2358-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24033","type":"LOCAL"},{"code":"257704","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24033 = Hospital System Supply Identifier | 257704 = Lawson ID"}]},{"description":"DISC - PLATE LOK DST VLR MED 4H LT","code_information":[{"code":"Sx00-2358-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24032","type":"LOCAL"},{"code":"257703","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24032 = Hospital System Supply Identifier | 257703 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 2H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24034","type":"LOCAL"},{"code":"257705","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24034 = Hospital System Supply Identifier | 257705 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 3H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24035","type":"LOCAL"},{"code":"257706","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24035 = Hospital System Supply Identifier | 257706 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 4H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24036","type":"LOCAL"},{"code":"257707","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24036 = Hospital System Supply Identifier | 257707 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 6H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24037","type":"LOCAL"},{"code":"257708","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24037 = Hospital System Supply Identifier | 257708 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 8H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24048","type":"LOCAL"},{"code":"257719","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24048 = Hospital System Supply Identifier | 257719 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 10H RT","code_information":[{"code":"Sx00-2358-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24049","type":"LOCAL"},{"code":"257720","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24049 = Hospital System Supply Identifier | 257720 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 8H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24050","type":"LOCAL"},{"code":"257721","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24050 = Hospital System Supply Identifier | 257721 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 10H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24051","type":"LOCAL"},{"code":"257722","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24051 = Hospital System Supply Identifier | 257722 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 6H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24041","type":"LOCAL"},{"code":"257712","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24041 = Hospital System Supply Identifier | 257712 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 3H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24039","type":"LOCAL"},{"code":"257710","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24039 = Hospital System Supply Identifier | 257710 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 2H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24038","type":"LOCAL"},{"code":"257709","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24038 = Hospital System Supply Identifier | 257709 = Lawson ID"}]},{"description":"DISC - PLATE DST DRSL T LOK 4H LT","code_information":[{"code":"Sx00-2358-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24040","type":"LOCAL"},{"code":"257711","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24040 = Hospital System Supply Identifier | 257711 = Lawson ID"}]},{"description":"PLATE LAT LOK DST HUM 5H RT","code_information":[{"code":"Sx00-2358-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383576","type":"LOCAL"},{"code":"395450","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383576 = Hospital System Supply Identifier | 395450 = Lawson ID"}]},{"description":"PLATE LAT LOK DST HUM 7H RT","code_information":[{"code":"Sx00-2358-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383577","type":"LOCAL"},{"code":"395451","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383577 = Hospital System Supply Identifier | 395451 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 5H LT","code_information":[{"code":"Sx00-2358-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384414","type":"LOCAL"},{"code":"410440","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384414 = Hospital System Supply Identifier | 410440 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 9H LT","code_information":[{"code":"Sx00-2358-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384415","type":"LOCAL"},{"code":"410441","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384415 = Hospital System Supply Identifier | 410441 = Lawson ID"}]},{"description":"DISC - PLATE LOK RAD DST 52MM 2H RT","code_information":[{"code":"Sx00-2358-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384416","type":"LOCAL"},{"code":"410442","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384416 = Hospital System Supply Identifier | 410442 = Lawson ID"}]},{"description":"DISC - PLATE LOK RAD DST 74MM 4H RT","code_information":[{"code":"Sx00-2358-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384417","type":"LOCAL"},{"code":"410443","type":"LOCAL"}],"standard_charges":[{"gross_charge":3062.4,"discounted_cash":2143.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384417 = Hospital System Supply Identifier | 410443 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 74MM 3H RT","code_information":[{"code":"Sx00-2358-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384418","type":"LOCAL"},{"code":"410444","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384418 = Hospital System Supply Identifier | 410444 = Lawson ID"}]},{"description":"PLATE LOK DST HUM 7H RT","code_information":[{"code":"Sx00-2358-107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383578","type":"LOCAL"},{"code":"395452","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383578 = Hospital System Supply Identifier | 395452 = Lawson ID"}]},{"description":"PLATE LOK DST HUM 3H LT","code_information":[{"code":"Sx00-2358-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383579","type":"LOCAL"},{"code":"395453","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383579 = Hospital System Supply Identifier | 395453 = Lawson ID"}]},{"description":"PLATE LOK HUM DST 100MM 5H LT","code_information":[{"code":"Sx00-2358-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384419","type":"LOCAL"},{"code":"410445","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384419 = Hospital System Supply Identifier | 410445 = Lawson ID"}]},{"description":"PLATE LOK PERI HD/LM 7HL 126MM","code_information":[{"code":"Sx00-2358-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384758","type":"LOCAL"},{"code":"432322","type":"LOCAL"}],"standard_charges":[{"gross_charge":2496.97,"discounted_cash":1747.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384758 = Hospital System Supply Identifier | 432322 = Lawson ID"}]},{"description":"SCREW PERIARTC LOK 2.4X12MM","code_information":[{"code":"Sx00-2359-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"23978","type":"LOCAL"},{"code":"257649","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23978 = Hospital System Supply Identifier | 257649 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X12","code_information":[{"code":"Sx00-2359-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"23995","type":"LOCAL"},{"code":"257666","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23995 = Hospital System Supply Identifier | 257666 = Lawson ID"}]},{"description":"SCREW PERIARTC LOK 2.4X14MM","code_information":[{"code":"Sx00-2359-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"23979","type":"LOCAL"},{"code":"257650","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23979 = Hospital System Supply Identifier | 257650 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X14","code_information":[{"code":"Sx00-2359-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"23996","type":"LOCAL"},{"code":"257667","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23996 = Hospital System Supply Identifier | 257667 = Lawson ID"}]},{"description":"SCREW PERIARTC LOK 2.4X16MM","code_information":[{"code":"Sx00-2359-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"23980","type":"LOCAL"},{"code":"257651","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23980 = Hospital System Supply Identifier | 257651 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X16","code_information":[{"code":"Sx00-2359-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"23997","type":"LOCAL"},{"code":"257668","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23997 = Hospital System Supply Identifier | 257668 = Lawson ID"}]},{"description":"SCREW PERIARTC LOK 2.4X18MM","code_information":[{"code":"Sx00-2359-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"23981","type":"LOCAL"},{"code":"257652","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23981 = Hospital System Supply Identifier | 257652 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X18","code_information":[{"code":"Sx00-2359-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"23998","type":"LOCAL"},{"code":"257669","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23998 = Hospital System Supply Identifier | 257669 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X22","code_information":[{"code":"Sx00-2359-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24000","type":"LOCAL"},{"code":"257671","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24000 = Hospital System Supply Identifier | 257671 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X24","code_information":[{"code":"Sx00-2359-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24001","type":"LOCAL"},{"code":"257672","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24001 = Hospital System Supply Identifier | 257672 = Lawson ID"}]},{"description":"SCREW PERIARTC CNCL LOK 2.4X26","code_information":[{"code":"Sx00-2359-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24002","type":"LOCAL"},{"code":"257673","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24002 = Hospital System Supply Identifier | 257673 = Lawson ID"}]},{"description":"SCREW PERIARTC LOK 2.4X32MM","code_information":[{"code":"Sx00-2359-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"23988","type":"LOCAL"},{"code":"257659","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23988 = Hospital System Supply Identifier | 257659 = Lawson ID"}]},{"description":"DISC - SCREW PERIARTC CNCL LOK 2.4X36","code_information":[{"code":"Sx00-2359-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24007","type":"LOCAL"},{"code":"257678","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24007 = Hospital System Supply Identifier | 257678 = Lawson ID"}]},{"description":"SCREW CNCL 2.7X40MM","code_information":[{"code":"Sx00-2359-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384672","type":"LOCAL"},{"code":"419227","type":"LOCAL"}],"standard_charges":[{"gross_charge":260.1,"discounted_cash":182.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384672 = Hospital System Supply Identifier | 419227 = Lawson ID"}]},{"description":"GWIRE 1.6MM DRL TIP","code_information":[{"code":"Sx00-2360-033","type":"CDM"},{"code":"272","type":"RC"},{"code":"27094","type":"LOCAL"},{"code":"312606","type":"LOCAL"}],"standard_charges":[{"gross_charge":279.45,"discounted_cash":195.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 27094 = Hospital System Supply Identifier | 312606 = Lawson ID"}]},{"description":"GWIRE ORTH SMTH DRL 1.6X229MM","code_information":[{"code":"Sx00-2360-036","type":"CDM"},{"code":"272","type":"RC"},{"code":"383811","type":"LOCAL"},{"code":"402351","type":"LOCAL"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383811 = Hospital System Supply Identifier | 402351 = Lawson ID"}]},{"description":"BIT DRILL CANN STD 4.7MM","code_information":[{"code":"Sx00-2360-071","type":"CDM"},{"code":"272","type":"RC"},{"code":"376011","type":"LOCAL"},{"code":"452326","type":"LOCAL"}],"standard_charges":[{"gross_charge":679.65,"discounted_cash":475.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 376011 = Hospital System Supply Identifier | 452326 = Lawson ID"}]},{"description":"BIT DRILL STD CANN Q/C 2.7MM","code_information":[{"code":"Sx00-2360-171","type":"CDM"},{"code":"272","type":"RC"},{"code":"27099","type":"LOCAL"},{"code":"312612","type":"LOCAL"}],"standard_charges":[{"gross_charge":571.3,"discounted_cash":399.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 27099 = Hospital System Supply Identifier | 312612 = Lawson ID"}]},{"description":"BIT DRILL STD CANN 2.0MM","code_information":[{"code":"Sx00-2360-175","type":"CDM"},{"code":"272","type":"RC"},{"code":"32487","type":"LOCAL"},{"code":"337133","type":"LOCAL"}],"standard_charges":[{"gross_charge":462.95,"discounted_cash":324.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32487 = Hospital System Supply Identifier | 337133 = Lawson ID"}]},{"description":"BIT DRILL STD CANN 2.7MM","code_information":[{"code":"Sx00-2360-205","type":"CDM"},{"code":"272","type":"RC"},{"code":"27096","type":"LOCAL"},{"code":"312608","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":179.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 27096 = Hospital System Supply Identifier | 312608 = Lawson ID"}]},{"description":"BIT DRILL STD CANN 3.7MM","code_information":[{"code":"Sx00-2360-225","type":"CDM"},{"code":"272","type":"RC"},{"code":"25001","type":"LOCAL"},{"code":"294680","type":"LOCAL"}],"standard_charges":[{"gross_charge":492.5,"discounted_cash":344.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 25001 = Hospital System Supply Identifier | 294680 = Lawson ID"}]},{"description":"NO USAGE - BIT DRILL AO 1.8X45MM","code_information":[{"code":"Sx00-2366-030","type":"CDM"},{"code":"272","type":"RC"},{"code":"190649","type":"LOCAL"},{"code":"462085","type":"LOCAL"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 190649 = Hospital System Supply Identifier | 462085 = Lawson ID"}]},{"description":"NO USAGE - BIT DRILL AO 2.4X45MM","code_information":[{"code":"Sx00-2366-030","type":"CDM"},{"code":"272","type":"RC"},{"code":"190650","type":"LOCAL"},{"code":"462086","type":"LOCAL"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 190650 = Hospital System Supply Identifier | 462086 = Lawson ID"}]},{"description":"DISC - BIT DRILL Q/C 2.7X125MM","code_information":[{"code":"Sx00-2410-028","type":"CDM"},{"code":"272","type":"RC"},{"code":"60315","type":"LOCAL"},{"code":"219371","type":"LOCAL"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":227.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 60315 = Hospital System Supply Identifier | 219371 = Lawson ID"}]},{"description":"BIT DRILL Q/C 2.5X216MM","code_information":[{"code":"Sx00-2410-029","type":"CDM"},{"code":"272","type":"RC"},{"code":"43859","type":"LOCAL"},{"code":"129466","type":"LOCAL"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":275.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 43859 = Hospital System Supply Identifier | 129466 = Lawson ID"}]},{"description":"DISC - BIT DRILL Q/C 3.5X195MM","code_information":[{"code":"Sx00-2410-036","type":"CDM"},{"code":"272","type":"RC"},{"code":"28627","type":"LOCAL"},{"code":"133734","type":"LOCAL"}],"standard_charges":[{"gross_charge":1419.0,"discounted_cash":993.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 28627 = Hospital System Supply Identifier | 133734 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X10MM","code_information":[{"code":"Sx00-2480-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4302","type":"LOCAL"},{"code":"157489","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4302 = Hospital System Supply Identifier | 157489 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X18MM","code_information":[{"code":"Sx00-2480-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4310","type":"LOCAL"},{"code":"157498","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4310 = Hospital System Supply Identifier | 157498 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X18MM","code_information":[{"code":"Sx00-2480-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4309","type":"LOCAL"},{"code":"157497","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4309 = Hospital System Supply Identifier | 157497 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X22MM","code_information":[{"code":"Sx00-2480-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4313","type":"LOCAL"},{"code":"157501","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4313 = Hospital System Supply Identifier | 157501 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X22MM","code_information":[{"code":"Sx00-2480-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4314","type":"LOCAL"},{"code":"157502","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4314 = Hospital System Supply Identifier | 157502 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X24MM","code_information":[{"code":"Sx00-2480-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4315","type":"LOCAL"},{"code":"157503","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4315 = Hospital System Supply Identifier | 157503 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X26MM","code_information":[{"code":"Sx00-2480-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4317","type":"LOCAL"},{"code":"157505","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4317 = Hospital System Supply Identifier | 157505 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X28MM","code_information":[{"code":"Sx00-2480-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4319","type":"LOCAL"},{"code":"157507","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4319 = Hospital System Supply Identifier | 157507 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X30MM","code_information":[{"code":"Sx00-2480-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4321","type":"LOCAL"},{"code":"157509","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4321 = Hospital System Supply Identifier | 157509 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X32MM","code_information":[{"code":"Sx00-2480-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4323","type":"LOCAL"},{"code":"157511","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4323 = Hospital System Supply Identifier | 157511 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X32MM","code_information":[{"code":"Sx00-2480-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4324","type":"LOCAL"},{"code":"157512","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4324 = Hospital System Supply Identifier | 157512 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X34MM","code_information":[{"code":"Sx00-2480-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4325","type":"LOCAL"},{"code":"157513","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4325 = Hospital System Supply Identifier | 157513 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X36MM","code_information":[{"code":"Sx00-2480-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4328","type":"LOCAL"},{"code":"157516","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4328 = Hospital System Supply Identifier | 157516 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X36MM","code_information":[{"code":"Sx00-2480-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4327","type":"LOCAL"},{"code":"157515","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4327 = Hospital System Supply Identifier | 157515 = Lawson ID"}]},{"description":"SCREW CANC FORTE P/T 4X38MM","code_information":[{"code":"Sx00-2480-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4329","type":"LOCAL"},{"code":"157517","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4329 = Hospital System Supply Identifier | 157517 = Lawson ID"}]},{"description":"SCREW CANC FORTE F/T 4X38MM","code_information":[{"code":"Sx00-2480-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4330","type":"LOCAL"},{"code":"157518","type":"LOCAL"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":146.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4330 = Hospital System Supply Identifier | 157518 = Lawson ID"}]},{"description":"PIN THRD 3X305MM","code_information":[{"code":"Sx00-2490-012","type":"CDM"},{"code":"272","type":"RC"},{"code":"383338","type":"LOCAL"},{"code":"389703","type":"LOCAL"}],"standard_charges":[{"gross_charge":420.55,"discounted_cash":294.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383338 = Hospital System Supply Identifier | 389703 = Lawson ID"}]},{"description":"BIT DRILL CANN FEMUR RF 4.9MM","code_information":[{"code":"Sx00-2490-034","type":"CDM"},{"code":"272","type":"RC"},{"code":"383581","type":"LOCAL"},{"code":"395456","type":"LOCAL"}],"standard_charges":[{"gross_charge":1284.7,"discounted_cash":899.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383581 = Hospital System Supply Identifier | 395456 = Lawson ID"}]},{"description":"PIN NAT N-THRD 3.0X355MM","code_information":[{"code":"Sx00-2490-047","type":"CDM"},{"code":"272","type":"RC"},{"code":"383372","type":"LOCAL"},{"code":"393312","type":"LOCAL"}],"standard_charges":[{"gross_charge":436.8,"discounted_cash":305.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383372 = Hospital System Supply Identifier | 393312 = Lawson ID"}]},{"description":"DRILL FREE HAND 4.3MM RED","code_information":[{"code":"Sx00-2490-075","type":"CDM"},{"code":"272","type":"RC"},{"code":"383359","type":"LOCAL"},{"code":"391784","type":"LOCAL"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383359 = Hospital System Supply Identifier | 391784 = Lawson ID"}]},{"description":"PLATE LOK PROX ULNA 7H RT","code_information":[{"code":"Sx00-2538-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"500465","type":"LOCAL"},{"code":"574913","type":"LOCAL"}],"standard_charges":[{"gross_charge":2272.88,"discounted_cash":1591.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 500465 = Hospital System Supply Identifier | 574913 = Lawson ID"}]},{"description":"PIN STNMN THRD STYLE 5 2.0X229","code_information":[{"code":"Sx00-2620-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"673610","type":"LOCAL"},{"code":"737012","type":"LOCAL"}],"standard_charges":[{"gross_charge":150.38,"discounted_cash":105.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 673610 = Hospital System Supply Identifier | 737012 = Lawson ID"}]},{"description":"PLATE L1 ORTHANC FLAT TAB 4H","code_information":[{"code":"Sx00-301-12-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"743221","type":"LOCAL"},{"code":"773378","type":"LOCAL"}],"standard_charges":[{"gross_charge":936.6,"discounted_cash":655.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 743221 = Hospital System Supply Identifier | 773378 = Lawson ID"}]},{"description":"PLATE L1 ORTHANC FLAT TAB 4H","code_information":[{"code":"Sx00-301-14-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"743222","type":"LOCAL"},{"code":"773379","type":"LOCAL"}],"standard_charges":[{"gross_charge":923.65,"discounted_cash":646.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 743222 = Hospital System Supply Identifier | 773379 = Lawson ID"}]},{"description":"PLATE L1 ORTHANC FLAT TAB 4H","code_information":[{"code":"Sx00-301-17-0","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"743223","type":"LOCAL"},{"code":"773380","type":"LOCAL"}],"standard_charges":[{"gross_charge":923.65,"discounted_cash":646.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 743223 = Hospital System Supply Identifier | 773380 = Lawson ID"}]},{"description":"FLEXFOAM STRIP 3INX25YD","code_information":[{"code":"Sx00-3861-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"41749","type":"LOCAL"},{"code":"255268","type":"LOCAL"}],"standard_charges":[{"gross_charge":272.95,"discounted_cash":191.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 41749 = Hospital System Supply Identifier | 255268 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX13","code_information":[{"code":"Sx00-4088-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279452","type":"LOCAL"},{"code":"521759","type":"LOCAL"}],"standard_charges":[{"gross_charge":6308.0,"discounted_cash":4415.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279452 = Hospital System Supply Identifier | 521759 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX14","code_information":[{"code":"Sx00-4088-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279458","type":"LOCAL"},{"code":"521765","type":"LOCAL"}],"standard_charges":[{"gross_charge":6308.0,"discounted_cash":4415.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279458 = Hospital System Supply Identifier | 521765 = Lawson ID"}]},{"description":"IMP HIP FEM STEM LM EXT 15MM","code_information":[{"code":"Sx00-4088-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279710","type":"LOCAL"},{"code":"521769","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279710 = Hospital System Supply Identifier | 521769 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 135DX15","code_information":[{"code":"Sx00-4088-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279712","type":"LOCAL"},{"code":"521771","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279712 = Hospital System Supply Identifier | 521771 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX15","code_information":[{"code":"Sx00-4088-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279713","type":"LOCAL"},{"code":"521772","type":"LOCAL"}],"standard_charges":[{"gross_charge":6308.0,"discounted_cash":4415.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279713 = Hospital System Supply Identifier | 521772 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX16","code_information":[{"code":"Sx00-4088-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279720","type":"LOCAL"},{"code":"521779","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279720 = Hospital System Supply Identifier | 521779 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 135DX16","code_information":[{"code":"Sx00-4088-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279719","type":"LOCAL"},{"code":"521778","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279719 = Hospital System Supply Identifier | 521778 = Lawson ID"}]},{"description":"IMP HIP FEM STEM LM EXT 16MM","code_information":[{"code":"Sx00-4088-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279717","type":"LOCAL"},{"code":"521776","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279717 = Hospital System Supply Identifier | 521776 = Lawson ID"}]},{"description":"IMP HIP FEM STEM LM EXT 17MM","code_information":[{"code":"Sx00-4088-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279724","type":"LOCAL"},{"code":"521783","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279724 = Hospital System Supply Identifier | 521783 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 135DX17","code_information":[{"code":"Sx00-4088-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279726","type":"LOCAL"},{"code":"521785","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279726 = Hospital System Supply Identifier | 521785 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX17","code_information":[{"code":"Sx00-4088-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279727","type":"LOCAL"},{"code":"521786","type":"LOCAL"}],"standard_charges":[{"gross_charge":6308.0,"discounted_cash":4415.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279727 = Hospital System Supply Identifier | 521786 = Lawson ID"}]},{"description":"IMP HIP FEM STEM LM EXT 18MM","code_information":[{"code":"Sx00-4088-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279731","type":"LOCAL"},{"code":"521790","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279731 = Hospital System Supply Identifier | 521790 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 135DX18","code_information":[{"code":"Sx00-4088-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279733","type":"LOCAL"},{"code":"521792","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279733 = Hospital System Supply Identifier | 521792 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX18","code_information":[{"code":"Sx00-4088-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279734","type":"LOCAL"},{"code":"521793","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279734 = Hospital System Supply Identifier | 521793 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 135DX19","code_information":[{"code":"Sx00-4088-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279737","type":"LOCAL"},{"code":"521796","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279737 = Hospital System Supply Identifier | 521796 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX19","code_information":[{"code":"Sx00-4088-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279738","type":"LOCAL"},{"code":"521797","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279738 = Hospital System Supply Identifier | 521797 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 125DX20","code_information":[{"code":"Sx00-4088-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279742","type":"LOCAL"},{"code":"521801","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279742 = Hospital System Supply Identifier | 521801 = Lawson ID"}]},{"description":"IMP HIP FEM STEM RNL 135DX20","code_information":[{"code":"Sx00-4088-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279741","type":"LOCAL"},{"code":"521800","type":"LOCAL"}],"standard_charges":[{"gross_charge":8578.5,"discounted_cash":6004.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279741 = Hospital System Supply Identifier | 521800 = Lawson ID"}]},{"description":"RESTRICTOR CEMENT 32MM STRL TRABECULAR METAL HIP ACETABULAR","code_information":[{"code":"Sx00-4199-001","type":"CDM"},{"code":"272","type":"RC"},{"code":"293968","type":"LOCAL"},{"code":"530002","type":"LOCAL"}],"standard_charges":[{"gross_charge":2849.94,"discounted_cash":1994.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 293968 = Hospital System Supply Identifier | 530002 = Lawson ID"}]},{"description":"IMP HIP ACET RSTRCT 38MM","code_information":[{"code":"Sx00-4199-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303143","type":"LOCAL"},{"code":"408140","type":"LOCAL"}],"standard_charges":[{"gross_charge":2947.56,"discounted_cash":2063.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303143 = Hospital System Supply Identifier | 408140 = Lawson ID"}]},{"description":"RESTRICTOR CEM ACET TM 26MM","code_information":[{"code":"Sx00-4199-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305826","type":"LOCAL"},{"code":"418233","type":"LOCAL"}],"standard_charges":[{"gross_charge":2947.56,"discounted_cash":2063.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305826 = Hospital System Supply Identifier | 418233 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM6X60MM","code_information":[{"code":"Sx00-4300-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279747","type":"LOCAL"},{"code":"521806","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279747 = Hospital System Supply Identifier | 521806 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM6X130MM","code_information":[{"code":"Sx00-4300-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279748","type":"LOCAL"},{"code":"521807","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279748 = Hospital System Supply Identifier | 521807 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 7X130MM","code_information":[{"code":"Sx00-4300-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"37185","type":"LOCAL"},{"code":"153980","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37185 = Hospital System Supply Identifier | 153980 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM BGLN 7","code_information":[{"code":"Sx00-4300-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"26456","type":"LOCAL"},{"code":"305404","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 26456 = Hospital System Supply Identifier | 305404 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM8X200MM","code_information":[{"code":"Sx00-4300-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279750","type":"LOCAL"},{"code":"521809","type":"LOCAL"}],"standard_charges":[{"gross_charge":8197.82,"discounted_cash":5738.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279750 = Hospital System Supply Identifier | 521809 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM8X170MM","code_information":[{"code":"Sx00-4300-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279749","type":"LOCAL"},{"code":"521808","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279749 = Hospital System Supply Identifier | 521808 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 8X130MM","code_information":[{"code":"Sx00-4300-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"37089","type":"LOCAL"},{"code":"147867","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37089 = Hospital System Supply Identifier | 147867 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 9X130MM","code_information":[{"code":"Sx00-4300-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"37176","type":"LOCAL"},{"code":"153062","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37176 = Hospital System Supply Identifier | 153062 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 10X130","code_information":[{"code":"Sx00-4300-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"37162","type":"LOCAL"},{"code":"151511","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37162 = Hospital System Supply Identifier | 151511 = Lawson ID"}]},{"description":"IMP SHLDR-T HUM STEM 10X170","code_information":[{"code":"Sx00-4300-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305622","type":"LOCAL"},{"code":"398068","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305622 = Hospital System Supply Identifier | 398068 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM10X200MM","code_information":[{"code":"Sx00-4300-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279751","type":"LOCAL"},{"code":"521810","type":"LOCAL"}],"standard_charges":[{"gross_charge":8197.82,"discounted_cash":5738.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279751 = Hospital System Supply Identifier | 521810 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 11X130","code_information":[{"code":"Sx00-4300-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"37266","type":"LOCAL"},{"code":"156812","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37266 = Hospital System Supply Identifier | 156812 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 12X130","code_information":[{"code":"Sx00-4300-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"133392","type":"LOCAL"},{"code":"148416","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 133392 = Hospital System Supply Identifier | 148416 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 12X170","code_information":[{"code":"Sx00-4300-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302492","type":"LOCAL"},{"code":"391786","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 302492 = Hospital System Supply Identifier | 391786 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM12X200MM","code_information":[{"code":"Sx00-4300-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279752","type":"LOCAL"},{"code":"521811","type":"LOCAL"}],"standard_charges":[{"gross_charge":8197.82,"discounted_cash":5738.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279752 = Hospital System Supply Identifier | 521811 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM BGLN 13","code_information":[{"code":"Sx00-4300-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"11700","type":"LOCAL"},{"code":"232672","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11700 = Hospital System Supply Identifier | 232672 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM14X170MM","code_information":[{"code":"Sx00-4300-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279753","type":"LOCAL"},{"code":"521812","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279753 = Hospital System Supply Identifier | 521812 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM14X200MM","code_information":[{"code":"Sx00-4300-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279754","type":"LOCAL"},{"code":"521813","type":"LOCAL"}],"standard_charges":[{"gross_charge":8197.82,"discounted_cash":5738.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279754 = Hospital System Supply Identifier | 521813 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM BGLN 14","code_information":[{"code":"Sx00-4300-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"12197","type":"LOCAL"},{"code":"236852","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12197 = Hospital System Supply Identifier | 236852 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 15X130","code_information":[{"code":"Sx00-4300-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"37349","type":"LOCAL"},{"code":"158629","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37349 = Hospital System Supply Identifier | 158629 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 16X130","code_information":[{"code":"Sx00-4300-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"12440","type":"LOCAL"},{"code":"237743","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12440 = Hospital System Supply Identifier | 237743 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM17X130MM","code_information":[{"code":"Sx00-4300-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279755","type":"LOCAL"},{"code":"521814","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279755 = Hospital System Supply Identifier | 521814 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM18X130MM","code_information":[{"code":"Sx00-4300-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279756","type":"LOCAL"},{"code":"521815","type":"LOCAL"}],"standard_charges":[{"gross_charge":5326.38,"discounted_cash":3728.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279756 = Hospital System Supply Identifier | 521815 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 40X24MM","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"37390","type":"LOCAL"},{"code":"160249","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37390 = Hospital System Supply Identifier | 160249 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD BGLN 40","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"12226","type":"LOCAL"},{"code":"236968","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12226 = Hospital System Supply Identifier | 236968 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM BGLN 40","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"23540","type":"LOCAL"},{"code":"254477","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23540 = Hospital System Supply Identifier | 254477 = Lawson ID"}]},{"description":"IMP GLEN COMP 46MM W/KEEL","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"30896","type":"LOCAL"},{"code":"323988","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 30896 = Hospital System Supply Identifier | 323988 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 15X40MM","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279757","type":"LOCAL"},{"code":"521816","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279757 = Hospital System Supply Identifier | 521816 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 27X40MM","code_information":[{"code":"Sx00-4300-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279758","type":"LOCAL"},{"code":"521817","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279758 = Hospital System Supply Identifier | 521817 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 33X46MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279762","type":"LOCAL"},{"code":"521821","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279762 = Hospital System Supply Identifier | 521821 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 30X46MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279761","type":"LOCAL"},{"code":"521820","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279761 = Hospital System Supply Identifier | 521820 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 27X46MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279760","type":"LOCAL"},{"code":"521819","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279760 = Hospital System Supply Identifier | 521819 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 24X46MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279759","type":"LOCAL"},{"code":"521818","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279759 = Hospital System Supply Identifier | 521818 = Lawson ID"}]},{"description":"IMP GLEN COMP 40MM W/KEEL","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279763","type":"LOCAL"},{"code":"521822","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279763 = Hospital System Supply Identifier | 521822 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 46X15MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"12212","type":"LOCAL"},{"code":"236915","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12212 = Hospital System Supply Identifier | 236915 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 46X18MM","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"37182","type":"LOCAL"},{"code":"153742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37182 = Hospital System Supply Identifier | 153742 = Lawson ID"}]},{"description":"HEAD HUMERAL","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302204","type":"LOCAL"},{"code":"148417","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 302204 = Hospital System Supply Identifier | 148417 = Lawson ID"}]},{"description":"IMP GLEN COMP 52MM W/KEEL","code_information":[{"code":"Sx00-4300-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"30897","type":"LOCAL"},{"code":"323989","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 30897 = Hospital System Supply Identifier | 323989 = Lawson ID"}]},{"description":"IMP SHLDR GLEN 52MM 56MM SURF","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279769","type":"LOCAL"},{"code":"521828","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279769 = Hospital System Supply Identifier | 521828 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 36X52MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279767","type":"LOCAL"},{"code":"521826","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279767 = Hospital System Supply Identifier | 521826 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 33X52MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279766","type":"LOCAL"},{"code":"521825","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279766 = Hospital System Supply Identifier | 521825 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 30X52MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279765","type":"LOCAL"},{"code":"521824","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279765 = Hospital System Supply Identifier | 521824 = Lawson ID"}]},{"description":"IMP SHLDR GLEN 52MM 46MM SURF","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279768","type":"LOCAL"},{"code":"521827","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279768 = Hospital System Supply Identifier | 521827 = Lawson ID"}]},{"description":"IMP HEAD STD GLEN 52X18MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302499","type":"LOCAL"},{"code":"392780","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 302499 = Hospital System Supply Identifier | 392780 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 52X21MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"23479","type":"LOCAL"},{"code":"253622","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 23479 = Hospital System Supply Identifier | 253622 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD 52X24MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305415","type":"LOCAL"},{"code":"157719","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305415 = Hospital System Supply Identifier | 157719 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 27X52MM","code_information":[{"code":"Sx00-4300-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279764","type":"LOCAL"},{"code":"521823","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279764 = Hospital System Supply Identifier | 521823 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 30X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279770","type":"LOCAL"},{"code":"521829","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279770 = Hospital System Supply Identifier | 521829 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 33X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279771","type":"LOCAL"},{"code":"521830","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279771 = Hospital System Supply Identifier | 521830 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 36X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279772","type":"LOCAL"},{"code":"521831","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279772 = Hospital System Supply Identifier | 521831 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 39X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279773","type":"LOCAL"},{"code":"521832","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279773 = Hospital System Supply Identifier | 521832 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD 42X56MM","code_information":[{"code":"Sx00-4300-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279774","type":"LOCAL"},{"code":"521833","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279774 = Hospital System Supply Identifier | 521833 = Lawson ID"}]},{"description":"IMP SHLDR GLEN KEEL 40MM","code_information":[{"code":"Sx00-4300-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279775","type":"LOCAL"},{"code":"521834","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279775 = Hospital System Supply Identifier | 521834 = Lawson ID"}]},{"description":"IMP SHLDR-T GLEN BGFW 46MM","code_information":[{"code":"Sx00-4300-081","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305602","type":"LOCAL"},{"code":"395459","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305602 = Hospital System Supply Identifier | 395459 = Lawson ID"}]},{"description":"IMP SHLDR TOT GLEN BGFW 52MM","code_information":[{"code":"Sx00-4300-082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"6571","type":"LOCAL"},{"code":"353753","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 6571 = Hospital System Supply Identifier | 353753 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP BGLN 85MM","code_information":[{"code":"Sx00-4300-085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"12363","type":"LOCAL"},{"code":"237455","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12363 = Hospital System Supply Identifier | 237455 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP BGLN 86MM","code_information":[{"code":"Sx00-4300-086","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"31511","type":"LOCAL"},{"code":"329977","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31511 = Hospital System Supply Identifier | 329977 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP BGLN 52MM","code_information":[{"code":"Sx00-4300-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"12196","type":"LOCAL"},{"code":"236851","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12196 = Hospital System Supply Identifier | 236851 = Lawson ID"}]},{"description":"PIN ALIGN SMTH BLNT SS 3X300MM","code_information":[{"code":"Sx00-4301-002","type":"CDM"},{"code":"272","type":"RC"},{"code":"37091","type":"LOCAL"},{"code":"147898","type":"LOCAL"}],"standard_charges":[{"gross_charge":368.4,"discounted_cash":257.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37091 = Hospital System Supply Identifier | 147898 = Lawson ID"}]},{"description":"SCREW BONE CANC F/T 6.5X80MM","code_information":[{"code":"Sx00-4301-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"279785","type":"LOCAL"},{"code":"521844","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279785 = Hospital System Supply Identifier | 521844 = Lawson ID"}]},{"description":"IMP SHLDR GLEN HD BGLN 40X46MM","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"12149","type":"LOCAL"},{"code":"236653","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12149 = Hospital System Supply Identifier | 236653 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 40X21","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"25018","type":"LOCAL"},{"code":"294860","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 25018 = Hospital System Supply Identifier | 294860 = Lawson ID"}]},{"description":"HEAD HUM OFFSET 18X40MM","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"388474","type":"LOCAL"},{"code":"386846","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 388474 = Hospital System Supply Identifier | 386846 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 15X40","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279786","type":"LOCAL"},{"code":"521845","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279786 = Hospital System Supply Identifier | 521845 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 24X40","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279787","type":"LOCAL"},{"code":"521846","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279787 = Hospital System Supply Identifier | 521846 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 27X40","code_information":[{"code":"Sx00-4302-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279788","type":"LOCAL"},{"code":"521847","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279788 = Hospital System Supply Identifier | 521847 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 30X46","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279790","type":"LOCAL"},{"code":"521849","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279790 = Hospital System Supply Identifier | 521849 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 27X46","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279789","type":"LOCAL"},{"code":"521848","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279789 = Hospital System Supply Identifier | 521848 = Lawson ID"}]},{"description":"IMP SHLDR GLEN PEG BF 46MM","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"388988","type":"LOCAL"},{"code":"439192","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 388988 = Hospital System Supply Identifier | 439192 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD BGFW 24X46MM","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302540","type":"LOCAL"},{"code":"395461","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 302540 = Hospital System Supply Identifier | 395461 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X15","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32776","type":"LOCAL"},{"code":"338927","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32776 = Hospital System Supply Identifier | 338927 = Lawson ID"}]},{"description":"IMP SHLDR GLEN BGLN PEGS 46X52","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"12081","type":"LOCAL"},{"code":"236319","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12081 = Hospital System Supply Identifier | 236319 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X17","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"11966","type":"LOCAL"},{"code":"235655","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11966 = Hospital System Supply Identifier | 235655 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X19","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"11699","type":"LOCAL"},{"code":"232671","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 11699 = Hospital System Supply Identifier | 232671 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X21","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"37187","type":"LOCAL"},{"code":"154319","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37187 = Hospital System Supply Identifier | 154319 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X18","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"37186","type":"LOCAL"},{"code":"153981","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37186 = Hospital System Supply Identifier | 153981 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 46X23","code_information":[{"code":"Sx00-4302-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"24930","type":"LOCAL"},{"code":"294264","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24930 = Hospital System Supply Identifier | 294264 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X27","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"7149","type":"LOCAL"},{"code":"357149","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 7149 = Hospital System Supply Identifier | 357149 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 33X52","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279791","type":"LOCAL"},{"code":"521850","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279791 = Hospital System Supply Identifier | 521850 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X30","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305138","type":"LOCAL"},{"code":"462716","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305138 = Hospital System Supply Identifier | 462716 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP W/PEG 52MM","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305903","type":"LOCAL"},{"code":"425659","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305903 = Hospital System Supply Identifier | 425659 = Lawson ID"}]},{"description":"IMP SHLDR GLEN COMP W/PEG 46MM","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32664","type":"LOCAL"},{"code":"337461","type":"LOCAL"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1792.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32664 = Hospital System Supply Identifier | 337461 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X21","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"12034","type":"LOCAL"},{"code":"236039","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12034 = Hospital System Supply Identifier | 236039 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X19","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"12080","type":"LOCAL"},{"code":"236316","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12080 = Hospital System Supply Identifier | 236316 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X23","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"12439","type":"LOCAL"},{"code":"237742","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12439 = Hospital System Supply Identifier | 237742 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X18","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"12019","type":"LOCAL"},{"code":"235970","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12019 = Hospital System Supply Identifier | 235970 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 52X24","code_information":[{"code":"Sx00-4302-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"37350","type":"LOCAL"},{"code":"158630","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37350 = Hospital System Supply Identifier | 158630 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD OFFS 24X56MM","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"388989","type":"LOCAL"},{"code":"439193","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 388989 = Hospital System Supply Identifier | 439193 = Lawson ID"}]},{"description":"IMP SHLDR HUM HD OFF BF 23X56","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145048","type":"LOCAL"},{"code":"386279","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 145048 = Hospital System Supply Identifier | 386279 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 56X27","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306355","type":"LOCAL"},{"code":"455945","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 306355 = Hospital System Supply Identifier | 455945 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 56X21","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305575","type":"LOCAL"},{"code":"380776","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305575 = Hospital System Supply Identifier | 380776 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM HD OFF 56X19","code_information":[{"code":"Sx00-4302-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"61701","type":"LOCAL"},{"code":"382420","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 61701 = Hospital System Supply Identifier | 382420 = Lawson ID"}]},{"description":"BIT DRILL BIGLIANI FLATOW TRABECULAR METAL 00430704200 2.5MM","code_information":[{"code":"Sx00-4307-042","type":"CDM"},{"code":"272","type":"RC"},{"code":"1250897","type":"LOCAL"},{"code":"1002289","type":"LOCAL"}],"standard_charges":[{"gross_charge":1291.84,"discounted_cash":904.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1250897 = Hospital System Supply Identifier | 1002289 = Lawson ID"}]},{"description":"BIT DRILL BIGLIANI FLATOW TRABECULAR METAL 00430704300 2.5MM","code_information":[{"code":"Sx00-4307-043","type":"CDM"},{"code":"272","type":"RC"},{"code":"1250899","type":"LOCAL"},{"code":"1002296","type":"LOCAL"}],"standard_charges":[{"gross_charge":1592.54,"discounted_cash":1114.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1250899 = Hospital System Supply Identifier | 1002296 = Lawson ID"}]},{"description":"ROD THRD ALIGN TM","code_information":[{"code":"Sx00-4309-009","type":"CDM"},{"code":"272","type":"RC"},{"code":"561495","type":"LOCAL"},{"code":"705155","type":"LOCAL"}],"standard_charges":[{"gross_charge":433.4,"discounted_cash":303.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 561495 = Hospital System Supply Identifier | 705155 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL 00430904515 7.5X15MM","code_information":[{"code":"Sx00-4309-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1250900","type":"LOCAL"},{"code":"1002366","type":"LOCAL"}],"standard_charges":[{"gross_charge":886.5,"discounted_cash":620.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1250900 = Hospital System Supply Identifier | 1002366 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL 00430904530 7.5X30MM","code_information":[{"code":"Sx00-4309-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1250901","type":"LOCAL"},{"code":"1002389","type":"LOCAL"}],"standard_charges":[{"gross_charge":886.5,"discounted_cash":620.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1250901 = Hospital System Supply Identifier | 1002389 = Lawson ID"}]},{"description":"BIT DRILL CANNULATED REVERSE TRABECULAR METAL 00430904615 7.5X15MM","code_information":[{"code":"Sx00-4309-046","type":"CDM"},{"code":"272","type":"RC"},{"code":"1223076","type":"LOCAL"},{"code":"1089894","type":"LOCAL"}],"standard_charges":[{"gross_charge":886.5,"discounted_cash":620.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1223076 = Hospital System Supply Identifier | 1089894 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 6X130MM","code_information":[{"code":"Sx00-4342-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279810","type":"LOCAL"},{"code":"521869","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279810 = Hospital System Supply Identifier | 521869 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 8X170MM","code_information":[{"code":"Sx00-4342-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279812","type":"LOCAL"},{"code":"521871","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279812 = Hospital System Supply Identifier | 521871 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 8X130MM","code_information":[{"code":"Sx00-4342-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279811","type":"LOCAL"},{"code":"521870","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279811 = Hospital System Supply Identifier | 521870 = Lawson ID"}]},{"description":"IMP SHLDR FEM STEM TM 9X130MM","code_information":[{"code":"Sx00-4342-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302542","type":"LOCAL"},{"code":"395464","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 302542 = Hospital System Supply Identifier | 395464 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 10X130","code_information":[{"code":"Sx00-4342-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302543","type":"LOCAL"},{"code":"395465","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 302543 = Hospital System Supply Identifier | 395465 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 10X170","code_information":[{"code":"Sx00-4342-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279813","type":"LOCAL"},{"code":"521872","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279813 = Hospital System Supply Identifier | 521872 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 11X130","code_information":[{"code":"Sx00-4342-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"25626","type":"LOCAL"},{"code":"298394","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 25626 = Hospital System Supply Identifier | 298394 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 12X130","code_information":[{"code":"Sx00-4342-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32669","type":"LOCAL"},{"code":"337466","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32669 = Hospital System Supply Identifier | 337466 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 12X170","code_information":[{"code":"Sx00-4342-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305908","type":"LOCAL"},{"code":"427929","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305908 = Hospital System Supply Identifier | 427929 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 12X130","code_information":[{"code":"Sx00-4342-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32670","type":"LOCAL"},{"code":"337467","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32670 = Hospital System Supply Identifier | 337467 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 14X130","code_information":[{"code":"Sx00-4342-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32671","type":"LOCAL"},{"code":"337468","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32671 = Hospital System Supply Identifier | 337468 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 14X170","code_information":[{"code":"Sx00-4342-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279814","type":"LOCAL"},{"code":"521873","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279814 = Hospital System Supply Identifier | 521873 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 15X130","code_information":[{"code":"Sx00-4342-115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"31510","type":"LOCAL"},{"code":"329976","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31510 = Hospital System Supply Identifier | 329976 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 16X170","code_information":[{"code":"Sx00-4342-116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"6570","type":"LOCAL"},{"code":"353752","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 6570 = Hospital System Supply Identifier | 353752 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 17X130","code_information":[{"code":"Sx00-4342-117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279815","type":"LOCAL"},{"code":"521874","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279815 = Hospital System Supply Identifier | 521874 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 42D 18X130","code_information":[{"code":"Sx00-4342-118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305574","type":"LOCAL"},{"code":"380775","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305574 = Hospital System Supply Identifier | 380775 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 6X130MM","code_information":[{"code":"Sx00-4348-106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279816","type":"LOCAL"},{"code":"521875","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279816 = Hospital System Supply Identifier | 521875 = Lawson ID"}]},{"description":"IMP SHLDR FEM STEM TM 8X130M","code_information":[{"code":"Sx00-4348-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"5533","type":"LOCAL"},{"code":"347343","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5533 = Hospital System Supply Identifier | 347343 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 8X170MM","code_information":[{"code":"Sx00-4348-108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279817","type":"LOCAL"},{"code":"521876","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279817 = Hospital System Supply Identifier | 521876 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM TM 9X130","code_information":[{"code":"Sx00-4348-109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"25017","type":"LOCAL"},{"code":"294859","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 25017 = Hospital System Supply Identifier | 294859 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 10X130","code_information":[{"code":"Sx00-4348-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"6534","type":"LOCAL"},{"code":"353527","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 6534 = Hospital System Supply Identifier | 353527 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 10X170","code_information":[{"code":"Sx00-4348-110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279818","type":"LOCAL"},{"code":"521877","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279818 = Hospital System Supply Identifier | 521877 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM TM 48DEG 11","code_information":[{"code":"Sx00-4348-111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"61704","type":"LOCAL"},{"code":"382516","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 61704 = Hospital System Supply Identifier | 382516 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 12X130","code_information":[{"code":"Sx00-4348-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"8070","type":"LOCAL"},{"code":"362853","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 8070 = Hospital System Supply Identifier | 362853 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 12X170","code_information":[{"code":"Sx00-4348-112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279819","type":"LOCAL"},{"code":"521878","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279819 = Hospital System Supply Identifier | 521878 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 13X130","code_information":[{"code":"Sx00-4348-113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"27480","type":"LOCAL"},{"code":"315005","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 27480 = Hospital System Supply Identifier | 315005 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 14X130","code_information":[{"code":"Sx00-4348-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"145040","type":"LOCAL"},{"code":"384917","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 145040 = Hospital System Supply Identifier | 384917 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48D 14X170","code_information":[{"code":"Sx00-4348-114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279820","type":"LOCAL"},{"code":"521879","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279820 = Hospital System Supply Identifier | 521879 = Lawson ID"}]},{"description":"IMP SHLDR STEM HUM TM 15X130","code_information":[{"code":"Sx00-4348-115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"24931","type":"LOCAL"},{"code":"294265","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24931 = Hospital System Supply Identifier | 294265 = Lawson ID"}]},{"description":"IMP SHLD HUM STEM 16X130 48DEG","code_information":[{"code":"Sx00-4348-116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"7148","type":"LOCAL"},{"code":"357148","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 7148 = Hospital System Supply Identifier | 357148 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM 48DEG 17MM","code_information":[{"code":"Sx00-4348-117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"76743","type":"LOCAL"},{"code":"372115","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 76743 = Hospital System Supply Identifier | 372115 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM TM 48DEG 18","code_information":[{"code":"Sx00-4348-118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"61700","type":"LOCAL"},{"code":"382419","type":"LOCAL"}],"standard_charges":[{"gross_charge":5500.74,"discounted_cash":3850.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 61700 = Hospital System Supply Identifier | 382419 = Lawson ID"}]},{"description":"IMP STEM HUM REV TM 8X170MM","code_information":[{"code":"Sx00-4349-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306331","type":"LOCAL"},{"code":"453439","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 306331 = Hospital System Supply Identifier | 453439 = Lawson ID"}]},{"description":"IMP SHLDR STEM REV TM 8X130MM","code_information":[{"code":"Sx00-4349-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305603","type":"LOCAL"},{"code":"395466","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305603 = Hospital System Supply Identifier | 395466 = Lawson ID"}]},{"description":"IMP HUM STEM REV 10X130MM","code_information":[{"code":"Sx00-4349-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32672","type":"LOCAL"},{"code":"337469","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32672 = Hospital System Supply Identifier | 337469 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 10X170","code_information":[{"code":"Sx00-4349-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279821","type":"LOCAL"},{"code":"521880","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279821 = Hospital System Supply Identifier | 521880 = Lawson ID"}]},{"description":"IMP SHLDR STEM REV TM 12X130MM","code_information":[{"code":"Sx00-4349-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32673","type":"LOCAL"},{"code":"337470","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32673 = Hospital System Supply Identifier | 337470 = Lawson ID"}]},{"description":"IMP SHLDR STEM REV TM 12X170MM","code_information":[{"code":"Sx00-4349-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32674","type":"LOCAL"},{"code":"337471","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32674 = Hospital System Supply Identifier | 337471 = Lawson ID"}]},{"description":"IMP SHLDR TOT HUM STEM 14MM","code_information":[{"code":"Sx00-4349-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32675","type":"LOCAL"},{"code":"337472","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32675 = Hospital System Supply Identifier | 337472 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 14X170","code_information":[{"code":"Sx00-4349-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279822","type":"LOCAL"},{"code":"521881","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279822 = Hospital System Supply Identifier | 521881 = Lawson ID"}]},{"description":"IMP SHLDR CAP BSPLT TM 15MM","code_information":[{"code":"Sx00-4349-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"189006","type":"LOCAL"},{"code":"416161","type":"LOCAL"}],"standard_charges":[{"gross_charge":3063.61,"discounted_cash":2144.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 189006 = Hospital System Supply Identifier | 416161 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 16X170","code_information":[{"code":"Sx00-4349-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279824","type":"LOCAL"},{"code":"521883","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279824 = Hospital System Supply Identifier | 521883 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 16X130","code_information":[{"code":"Sx00-4349-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279823","type":"LOCAL"},{"code":"521882","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279823 = Hospital System Supply Identifier | 521882 = Lawson ID"}]},{"description":"IMP SHLDR REV STEM TM 18X130MM","code_information":[{"code":"Sx00-4349-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305065","type":"LOCAL"},{"code":"458212","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305065 = Hospital System Supply Identifier | 458212 = Lawson ID"}]},{"description":"IMP SHLDR BSPLT REV 25MM POS","code_information":[{"code":"Sx00-4349-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279825","type":"LOCAL"},{"code":"521884","type":"LOCAL"}],"standard_charges":[{"gross_charge":3063.61,"discounted_cash":2144.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279825 = Hospital System Supply Identifier | 521884 = Lawson ID"}]},{"description":"IMP SHLDR BSPLT REV 30MM POS","code_information":[{"code":"Sx00-4349-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279826","type":"LOCAL"},{"code":"521885","type":"LOCAL"}],"standard_charges":[{"gross_charge":3063.61,"discounted_cash":2144.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279826 = Hospital System Supply Identifier | 521885 = Lawson ID"}]},{"description":"IMP LNR HUM INS TM REV 36MM","code_information":[{"code":"Sx00-4349-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32676","type":"LOCAL"},{"code":"337473","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32676 = Hospital System Supply Identifier | 337473 = Lawson ID"}]},{"description":"IMP LNR HUM INS TM PLS 36MM","code_information":[{"code":"Sx00-4349-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32677","type":"LOCAL"},{"code":"337474","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32677 = Hospital System Supply Identifier | 337474 = Lawson ID"}]},{"description":"IMP LNR HUM INS TM REV 36X6MM","code_information":[{"code":"Sx00-4349-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32678","type":"LOCAL"},{"code":"337475","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32678 = Hospital System Supply Identifier | 337475 = Lawson ID"}]},{"description":"IMP SHLDR GLEN 36MM","code_information":[{"code":"Sx00-4349-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32679","type":"LOCAL"},{"code":"337476","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32679 = Hospital System Supply Identifier | 337476 = Lawson ID"}]},{"description":"IMP SHLDR HUM INS 37X0MM","code_information":[{"code":"Sx00-4349-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32680","type":"LOCAL"},{"code":"337477","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32680 = Hospital System Supply Identifier | 337477 = Lawson ID"}]},{"description":"IMP SHLDR BSPLT TM REV STRL","code_information":[{"code":"Sx00-4349-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32681","type":"LOCAL"},{"code":"337478","type":"LOCAL"}],"standard_charges":[{"gross_charge":6232.0,"discounted_cash":4362.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32681 = Hospital System Supply Identifier | 337478 = Lawson ID"}]},{"description":"IMP SPCR TRABCLR MTL 12MM","code_information":[{"code":"Sx00-4349-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"7418","type":"LOCAL"},{"code":"360582","type":"LOCAL"}],"standard_charges":[{"gross_charge":1355.36,"discounted_cash":948.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 7418 = Hospital System Supply Identifier | 360582 = Lawson ID"}]},{"description":"IMP SHLDR SPCR TRAB MTL 9MM","code_information":[{"code":"Sx00-4349-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"32682","type":"LOCAL"},{"code":"337479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1355.36,"discounted_cash":948.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32682 = Hospital System Supply Identifier | 337479 = Lawson ID"}]},{"description":"IMP SHLDR GLEN TM REV 40MM","code_information":[{"code":"Sx00-4349-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"7419","type":"LOCAL"},{"code":"360583","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 7419 = Hospital System Supply Identifier | 360583 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS 40X0MM","code_information":[{"code":"Sx00-4349-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"96122","type":"LOCAL"},{"code":"398116","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 96122 = Hospital System Supply Identifier | 398116 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS3 40MM","code_information":[{"code":"Sx00-4349-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279827","type":"LOCAL"},{"code":"521886","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279827 = Hospital System Supply Identifier | 521886 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS6 40MM","code_information":[{"code":"Sx00-4349-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279828","type":"LOCAL"},{"code":"521887","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279828 = Hospital System Supply Identifier | 521887 = Lawson ID"}]},{"description":"IMP LNR TM REV POLY 36MM 3","code_information":[{"code":"Sx00-4349-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"7422","type":"LOCAL"},{"code":"360586","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 7422 = Hospital System Supply Identifier | 360586 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS 6 65D 36","code_information":[{"code":"Sx00-4349-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"7423","type":"LOCAL"},{"code":"360587","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 7423 = Hospital System Supply Identifier | 360587 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS0 65D 36M","code_information":[{"code":"Sx00-4349-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"183917","type":"LOCAL"},{"code":"459002","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 183917 = Hospital System Supply Identifier | 459002 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS6 65D 40","code_information":[{"code":"Sx00-4349-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279830","type":"LOCAL"},{"code":"521889","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279830 = Hospital System Supply Identifier | 521889 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS0 65D 40M","code_information":[{"code":"Sx00-4349-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"498105","type":"LOCAL"},{"code":"459445","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 498105 = Hospital System Supply Identifier | 459445 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR PLS3 65D 40","code_information":[{"code":"Sx00-4349-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279829","type":"LOCAL"},{"code":"521888","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279829 = Hospital System Supply Identifier | 521888 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 6X13","code_information":[{"code":"Sx00-4350-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279831","type":"LOCAL"},{"code":"521890","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279831 = Hospital System Supply Identifier | 521890 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 8X13","code_information":[{"code":"Sx00-4350-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279832","type":"LOCAL"},{"code":"521891","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279832 = Hospital System Supply Identifier | 521891 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 8X20","code_information":[{"code":"Sx00-4350-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279833","type":"LOCAL"},{"code":"521892","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279833 = Hospital System Supply Identifier | 521892 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 9X13","code_information":[{"code":"Sx00-4350-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279834","type":"LOCAL"},{"code":"521893","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279834 = Hospital System Supply Identifier | 521893 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 10X1","code_information":[{"code":"Sx00-4350-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279835","type":"LOCAL"},{"code":"521894","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279835 = Hospital System Supply Identifier | 521894 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 10X20","code_information":[{"code":"Sx00-4350-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279836","type":"LOCAL"},{"code":"521895","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279836 = Hospital System Supply Identifier | 521895 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 11X1","code_information":[{"code":"Sx00-4350-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279837","type":"LOCAL"},{"code":"521896","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279837 = Hospital System Supply Identifier | 521896 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 12X1","code_information":[{"code":"Sx00-4350-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279838","type":"LOCAL"},{"code":"521897","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279838 = Hospital System Supply Identifier | 521897 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 12X20","code_information":[{"code":"Sx00-4350-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279839","type":"LOCAL"},{"code":"521898","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279839 = Hospital System Supply Identifier | 521898 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 13X1","code_information":[{"code":"Sx00-4350-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279840","type":"LOCAL"},{"code":"521899","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279840 = Hospital System Supply Identifier | 521899 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 14X1","code_information":[{"code":"Sx00-4350-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279841","type":"LOCAL"},{"code":"521900","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279841 = Hospital System Supply Identifier | 521900 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 14X20","code_information":[{"code":"Sx00-4350-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279842","type":"LOCAL"},{"code":"521901","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279842 = Hospital System Supply Identifier | 521901 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 15X1","code_information":[{"code":"Sx00-4350-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279843","type":"LOCAL"},{"code":"521902","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279843 = Hospital System Supply Identifier | 521902 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 16X1","code_information":[{"code":"Sx00-4350-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279844","type":"LOCAL"},{"code":"521903","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279844 = Hospital System Supply Identifier | 521903 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 16X20","code_information":[{"code":"Sx00-4350-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279845","type":"LOCAL"},{"code":"521904","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279845 = Hospital System Supply Identifier | 521904 = Lawson ID"}]},{"description":"IMP SHLDR HUM STEM REV 18X1","code_information":[{"code":"Sx00-4350-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"279846","type":"LOCAL"},{"code":"521905","type":"LOCAL"}],"standard_charges":[{"gross_charge":8123.62,"discounted_cash":5686.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 279846 = Hospital System Supply Identifier | 521905 = Lawson ID"}]},{"description":"IMP SHLDR LNR XLNK PLS 336MM","code_information":[{"code":"Sx00-4350-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"510781","type":"LOCAL"},{"code":"665299","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 510781 = Hospital System Supply Identifier | 665299 = Lawson ID"}]},{"description":"IMP SHLDR LNR VIT E 36MM PLS6","code_information":[{"code":"Sx00-4350-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"561496","type":"LOCAL"},{"code":"705156","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 561496 = Hospital System Supply Identifier | 705156 = Lawson ID"}]},{"description":"IMP SHLDR LNR XLNK POLY 35MM","code_information":[{"code":"Sx00-4350-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"510695","type":"LOCAL"},{"code":"663511","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 510695 = Hospital System Supply Identifier | 663511 = Lawson ID"}]},{"description":"IMP SHLDR LNR VIT E 40MM PLS6","code_information":[{"code":"Sx00-4350-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"561499","type":"LOCAL"},{"code":"705159","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 561499 = Hospital System Supply Identifier | 705159 = Lawson ID"}]},{"description":"IMP SHLDR LNR VIT E 40MM PLS0","code_information":[{"code":"Sx00-4350-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"561497","type":"LOCAL"},{"code":"705157","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 561497 = Hospital System Supply Identifier | 705157 = Lawson ID"}]},{"description":"IMP SHLDR LNR VIT E 40MM PLS3","code_information":[{"code":"Sx00-4350-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"561498","type":"LOCAL"},{"code":"705158","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 561498 = Hospital System Supply Identifier | 705158 = Lawson ID"}]},{"description":"IMP SHLDR REV LNR 3MM OFFSET","code_information":[{"code":"Sx00-4350-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"510575","type":"LOCAL"},{"code":"659495","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 510575 = Hospital System Supply Identifier | 659495 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 36MM PL0","code_information":[{"code":"Sx00-4350-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"561500","type":"LOCAL"},{"code":"705160","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 561500 = Hospital System Supply Identifier | 705160 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 36MM PL6","code_information":[{"code":"Sx00-4350-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"561501","type":"LOCAL"},{"code":"705161","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 561501 = Hospital System Supply Identifier | 705161 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 40MM PL0","code_information":[{"code":"Sx00-4350-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"561502","type":"LOCAL"},{"code":"705162","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 561502 = Hospital System Supply Identifier | 705162 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 40MM PL3","code_information":[{"code":"Sx00-4350-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"561503","type":"LOCAL"},{"code":"705163","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 561503 = Hospital System Supply Identifier | 705163 = Lawson ID"}]},{"description":"IMP LNR 65D RET VIT E 40MM PL6","code_information":[{"code":"Sx00-4350-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"561504","type":"LOCAL"},{"code":"705164","type":"LOCAL"}],"standard_charges":[{"gross_charge":2160.86,"discounted_cash":1512.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 561504 = Hospital System Supply Identifier | 705164 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS0MM 36MM","code_information":[{"code":"Sx00-4360-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766327","type":"LOCAL"},{"code":"777519","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766327 = Hospital System Supply Identifier | 777519 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS2MM 36MM","code_information":[{"code":"Sx00-4360-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766328","type":"LOCAL"},{"code":"777520","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766328 = Hospital System Supply Identifier | 777520 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS2.5MM 40MM","code_information":[{"code":"Sx00-4360-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766330","type":"LOCAL"},{"code":"777522","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766330 = Hospital System Supply Identifier | 777522 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS0MM 40MM","code_information":[{"code":"Sx00-4360-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766329","type":"LOCAL"},{"code":"777521","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766329 = Hospital System Supply Identifier | 777521 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL REVERSE PLUS 00436104525 7.5X25MM","code_information":[{"code":"Sx00-4361-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1250903","type":"LOCAL"},{"code":"1002281","type":"LOCAL"}],"standard_charges":[{"gross_charge":1257.96,"discounted_cash":880.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1250903 = Hospital System Supply Identifier | 1002281 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL REVERSE PLUS 00436104515 7.5X15MM","code_information":[{"code":"Sx00-4361-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"1250902","type":"LOCAL"},{"code":"1002374","type":"LOCAL"}],"standard_charges":[{"gross_charge":1257.96,"discounted_cash":880.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1250902 = Hospital System Supply Identifier | 1002374 = Lawson ID"}]},{"description":"BIT DRILL REVERSE SHOULDER TRABECULAR METAL 00436107330 7.5X30MM","code_information":[{"code":"Sx00-4361-073","type":"CDM"},{"code":"272","type":"RC"},{"code":"1223077","type":"LOCAL"},{"code":"1089674","type":"LOCAL"}],"standard_charges":[{"gross_charge":731.35,"discounted_cash":511.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1223077 = Hospital System Supply Identifier | 1089674 = Lawson ID"}]},{"description":"BIT DRILL REVERSE SHOULDER TRABECULAR METAL 00436107325 7.5X25MM","code_information":[{"code":"Sx00-4361-073","type":"CDM"},{"code":"272","type":"RC"},{"code":"1223078","type":"LOCAL"},{"code":"1089841","type":"LOCAL"}],"standard_charges":[{"gross_charge":731.35,"discounted_cash":511.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1223078 = Hospital System Supply Identifier | 1089841 = Lawson ID"}]},{"description":"BIT DRILL REVERSE SHOULDER TRABECULAR METAL 00436107320 7.5X20MM","code_information":[{"code":"Sx00-4361-073","type":"CDM"},{"code":"272","type":"RC"},{"code":"1223080","type":"LOCAL"},{"code":"1089856","type":"LOCAL"}],"standard_charges":[{"gross_charge":731.35,"discounted_cash":511.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1223080 = Hospital System Supply Identifier | 1089856 = Lawson ID"}]},{"description":"BIT DRILL TRABECULAR METAL 00436107315 7.5X15MM","code_information":[{"code":"Sx00-4361-073","type":"CDM"},{"code":"272","type":"RC"},{"code":"1223081","type":"LOCAL"},{"code":"1090098","type":"LOCAL"}],"standard_charges":[{"gross_charge":731.35,"discounted_cash":511.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1223081 = Hospital System Supply Identifier | 1090098 = Lawson ID"}]},{"description":"BASEPLATE GLEN REV 15X26MM","code_information":[{"code":"Sx00-4362-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766331","type":"LOCAL"},{"code":"777523","type":"LOCAL"}],"standard_charges":[{"gross_charge":3063.61,"discounted_cash":2144.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766331 = Hospital System Supply Identifier | 777523 = Lawson ID"}]},{"description":"BASEPLATE GLEN REV 20X26MM","code_information":[{"code":"Sx00-4362-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766332","type":"LOCAL"},{"code":"777524","type":"LOCAL"}],"standard_charges":[{"gross_charge":3063.61,"discounted_cash":2144.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766332 = Hospital System Supply Identifier | 777524 = Lawson ID"}]},{"description":"BASEPLATE GLEN REV 25X26MM","code_information":[{"code":"Sx00-4362-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766333","type":"LOCAL"},{"code":"777525","type":"LOCAL"}],"standard_charges":[{"gross_charge":3063.61,"discounted_cash":2144.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766333 = Hospital System Supply Identifier | 777525 = Lawson ID"}]},{"description":"BASEPLATE GLEN REV 30X26MM","code_information":[{"code":"Sx00-4362-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766334","type":"LOCAL"},{"code":"777526","type":"LOCAL"}],"standard_charges":[{"gross_charge":3063.61,"discounted_cash":2144.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766334 = Hospital System Supply Identifier | 777526 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS3MM 36MM","code_information":[{"code":"Sx00-4363-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766335","type":"LOCAL"},{"code":"777527","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766335 = Hospital System Supply Identifier | 777527 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS3MM ECC 36MM","code_information":[{"code":"Sx00-4363-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766336","type":"LOCAL"},{"code":"777528","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766336 = Hospital System Supply Identifier | 777528 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS3MM 40MM","code_information":[{"code":"Sx00-4363-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766337","type":"LOCAL"},{"code":"777529","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766337 = Hospital System Supply Identifier | 777529 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS3MM ECC 40MM","code_information":[{"code":"Sx00-4363-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766338","type":"LOCAL"},{"code":"777530","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766338 = Hospital System Supply Identifier | 777530 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS5MM 36MM","code_information":[{"code":"Sx00-4365-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766339","type":"LOCAL"},{"code":"777531","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766339 = Hospital System Supply Identifier | 777531 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS5MM ECC 36MM","code_information":[{"code":"Sx00-4365-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766340","type":"LOCAL"},{"code":"777532","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766340 = Hospital System Supply Identifier | 777532 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS5MM 40MM","code_information":[{"code":"Sx00-4365-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766341","type":"LOCAL"},{"code":"777533","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766341 = Hospital System Supply Identifier | 777533 = Lawson ID"}]},{"description":"COMP GLENOSPHR PLS5MM ECC 40MM","code_information":[{"code":"Sx00-4365-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"766342","type":"LOCAL"},{"code":"777534","type":"LOCAL"}],"standard_charges":[{"gross_charge":2827.93,"discounted_cash":1979.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 766342 = Hospital System Supply Identifier | 777534 = Lawson ID"}]},{"description":"IMP HIP ACET LNR TM 36MM 0","code_information":[{"code":"Sx00-4390-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"7420","type":"LOCAL"},{"code":"360584","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 7420 = Hospital System Supply Identifier | 360584 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450001100 SIZE 1","code_information":[{"code":"Sx00-4500-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279789","type":"LOCAL"},{"code":"1100786","type":"LOCAL"}],"standard_charges":[{"gross_charge":15312.0,"discounted_cash":10718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279789 = Hospital System Supply Identifier | 1100786 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450001400 SIZE 4","code_information":[{"code":"Sx00-4500-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279769","type":"LOCAL"},{"code":"1100803","type":"LOCAL"}],"standard_charges":[{"gross_charge":15312.0,"discounted_cash":10718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279769 = Hospital System Supply Identifier | 1100803 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450001500 SIZE 5","code_information":[{"code":"Sx00-4500-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279787","type":"LOCAL"},{"code":"1100782","type":"LOCAL"}],"standard_charges":[{"gross_charge":15312.0,"discounted_cash":10718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279787 = Hospital System Supply Identifier | 1100782 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450001600 SIZE 6","code_information":[{"code":"Sx00-4500-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279767","type":"LOCAL"},{"code":"1100806","type":"LOCAL"}],"standard_charges":[{"gross_charge":15312.0,"discounted_cash":10718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279767 = Hospital System Supply Identifier | 1100806 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002100 SIZE 1","code_information":[{"code":"Sx00-4500-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279795","type":"LOCAL"},{"code":"1100784","type":"LOCAL"}],"standard_charges":[{"gross_charge":15312.0,"discounted_cash":10718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279795 = Hospital System Supply Identifier | 1100784 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002200 SIZE 2","code_information":[{"code":"Sx00-4500-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279799","type":"LOCAL"},{"code":"1100789","type":"LOCAL"}],"standard_charges":[{"gross_charge":15312.0,"discounted_cash":10718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279799 = Hospital System Supply Identifier | 1100789 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002300 SIZE 3","code_information":[{"code":"Sx00-4500-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279766","type":"LOCAL"},{"code":"1100792","type":"LOCAL"}],"standard_charges":[{"gross_charge":15312.0,"discounted_cash":10718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279766 = Hospital System Supply Identifier | 1100792 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002400 SIZE 4","code_information":[{"code":"Sx00-4500-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279779","type":"LOCAL"},{"code":"1100817","type":"LOCAL"}],"standard_charges":[{"gross_charge":15312.0,"discounted_cash":10718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279779 = Hospital System Supply Identifier | 1100817 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002500 SIZE 5","code_information":[{"code":"Sx00-4500-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279792","type":"LOCAL"},{"code":"1100801","type":"LOCAL"}],"standard_charges":[{"gross_charge":15312.0,"discounted_cash":10718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279792 = Hospital System Supply Identifier | 1100801 = Lawson ID"}]},{"description":"ANKLE JOINT TALAR COMPONENT TRABECULAR METAL 00450002600 SIZE 6","code_information":[{"code":"Sx00-4500-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279772","type":"LOCAL"},{"code":"1100813","type":"LOCAL"}],"standard_charges":[{"gross_charge":15312.0,"discounted_cash":10718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279772 = Hospital System Supply Identifier | 1100813 = Lawson ID"}]},{"description":"ANKLE JOINT TIBIAL COMPONENT TRABECULAR METAL 00450004100 SIZE 1","code_information":[{"code":"Sx00-4500-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279761","type":"LOCAL"},{"code":"1100797","type":"LOCAL"}],"standard_charges":[{"gross_charge":11880.0,"discounted_cash":8316.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279761 = Hospital System Supply Identifier | 1100797 = Lawson ID"}]},{"description":"ANKLE JOINT TIBIAL COMPONENT TRABECULAR METAL 00450004400 SIZE 4","code_information":[{"code":"Sx00-4500-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279777","type":"LOCAL"},{"code":"1100808","type":"LOCAL"}],"standard_charges":[{"gross_charge":11880.0,"discounted_cash":8316.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279777 = Hospital System Supply Identifier | 1100808 = Lawson ID"}]},{"description":"ANKLE JOINT TIBIAL COMPONENT TRABECULAR METAL 00450004500 SIZE 5","code_information":[{"code":"Sx00-4500-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279763","type":"LOCAL"},{"code":"1100780","type":"LOCAL"}],"standard_charges":[{"gross_charge":11880.0,"discounted_cash":8316.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279763 = Hospital System Supply Identifier | 1100780 = Lawson ID"}]},{"description":"ANKLE JOINT TIBIAL COMPONENT TRABECULAR METAL 00450004600 SIZE 6","code_information":[{"code":"Sx00-4500-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279793","type":"LOCAL"},{"code":"1100810","type":"LOCAL"}],"standard_charges":[{"gross_charge":11880.0,"discounted_cash":8316.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279793 = Hospital System Supply Identifier | 1100810 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005102 2 SIZE 1","code_information":[{"code":"Sx00-4500-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279785","type":"LOCAL"},{"code":"1100804","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279785 = Hospital System Supply Identifier | 1100804 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005104 4 SIZE 1","code_information":[{"code":"Sx00-4500-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279797","type":"LOCAL"},{"code":"1100812","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279797 = Hospital System Supply Identifier | 1100812 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005100 0 SIZE 1","code_information":[{"code":"Sx00-4500-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279801","type":"LOCAL"},{"code":"1100824","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279801 = Hospital System Supply Identifier | 1100824 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005202 2 SIZE 2","code_information":[{"code":"Sx00-4500-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279781","type":"LOCAL"},{"code":"1100791","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279781 = Hospital System Supply Identifier | 1100791 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005204 4 SIZE 2","code_information":[{"code":"Sx00-4500-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279764","type":"LOCAL"},{"code":"1100805","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279764 = Hospital System Supply Identifier | 1100805 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005304 4 SIZE 3","code_information":[{"code":"Sx00-4500-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279786","type":"LOCAL"},{"code":"1100821","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279786 = Hospital System Supply Identifier | 1100821 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005302 2 SIZE 3","code_information":[{"code":"Sx00-4500-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279778","type":"LOCAL"},{"code":"1100820","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279778 = Hospital System Supply Identifier | 1100820 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005402 2 SIZE 4","code_information":[{"code":"Sx00-4500-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279788","type":"LOCAL"},{"code":"1100785","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279788 = Hospital System Supply Identifier | 1100785 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005400 0 SIZE 4","code_information":[{"code":"Sx00-4500-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279791","type":"LOCAL"},{"code":"1100790","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279791 = Hospital System Supply Identifier | 1100790 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005404 4 SIZE 4","code_information":[{"code":"Sx00-4500-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279796","type":"LOCAL"},{"code":"1100811","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279796 = Hospital System Supply Identifier | 1100811 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005500 0 SIZE 5","code_information":[{"code":"Sx00-4500-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279774","type":"LOCAL"},{"code":"1100779","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279774 = Hospital System Supply Identifier | 1100779 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005502 2 SIZE 5","code_information":[{"code":"Sx00-4500-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279757","type":"LOCAL"},{"code":"1100781","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279757 = Hospital System Supply Identifier | 1100781 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005504 4 SIZE 5","code_information":[{"code":"Sx00-4500-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279775","type":"LOCAL"},{"code":"1100787","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279775 = Hospital System Supply Identifier | 1100787 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005602 2 SIZE 6","code_information":[{"code":"Sx00-4500-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279790","type":"LOCAL"},{"code":"1100799","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279790 = Hospital System Supply Identifier | 1100799 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005604 4 SIZE 6","code_information":[{"code":"Sx00-4500-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279758","type":"LOCAL"},{"code":"1100783","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279758 = Hospital System Supply Identifier | 1100783 = Lawson ID"}]},{"description":"ANKLE JOINT INSERT TRABECULAR METAL PROLONG 00450005600 0 SIZE 6","code_information":[{"code":"Sx00-4500-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1279765","type":"LOCAL"},{"code":"1100788","type":"LOCAL"}],"standard_charges":[{"gross_charge":6946.0,"discounted_cash":4862.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1279765 = Hospital System Supply Identifier | 1100788 = Lawson ID"}]},{"description":"PIN FIX EXTR TRAB MTL ANK 200X","code_information":[{"code":"Sx00-4501-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"611283","type":"LOCAL"},{"code":"607571","type":"LOCAL"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":402.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 611283 = Hospital System Supply Identifier | 607571 = Lawson ID"}]},{"description":"K-WIRE FIX TEMP 1.6MM","code_information":[{"code":"Sx00-4501-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"611281","type":"LOCAL"},{"code":"607569","type":"LOCAL"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 611281 = Hospital System Supply Identifier | 607569 = Lawson ID"}]},{"description":"DRILL SURGICAL SLEEVE","code_information":[{"code":"Sx00-4501-041","type":"CDM"},{"code":"272","type":"RC"},{"code":"691333","type":"LOCAL"},{"code":"607572","type":"LOCAL"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 691333 = Hospital System Supply Identifier | 607572 = Lawson ID"}]},{"description":"BIT DRILL ZPS QC 1.1X60MM","code_information":[{"code":"Sx00-4806-060","type":"CDM"},{"code":"272","type":"RC"},{"code":"5326","type":"LOCAL"},{"code":"345074","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.05,"discounted_cash":182.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5326 = Hospital System Supply Identifier | 345074 = Lawson ID"}]},{"description":"BIT DRILL ZPS QC 1.5X85MM","code_information":[{"code":"Sx00-4806-085","type":"CDM"},{"code":"272","type":"RC"},{"code":"5327","type":"LOCAL"},{"code":"345075","type":"LOCAL"}],"standard_charges":[{"gross_charge":261.05,"discounted_cash":182.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5327 = Hospital System Supply Identifier | 345075 = Lawson ID"}]},{"description":"BIT DRILL Q-C 2.0MM","code_information":[{"code":"Sx00-4806-100","type":"CDM"},{"code":"272","type":"RC"},{"code":"41514","type":"LOCAL"},{"code":"157437","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":179.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 41514 = Hospital System Supply Identifier | 157437 = Lawson ID"}]},{"description":"BIT DRILL Q-C 2.7MM","code_information":[{"code":"Sx00-4806-100","type":"CDM"},{"code":"272","type":"RC"},{"code":"53311","type":"LOCAL"},{"code":"157438","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":179.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53311 = Hospital System Supply Identifier | 157438 = Lawson ID"}]},{"description":"BIT DRILL Q-C 2.5MM","code_information":[{"code":"Sx00-4806-110","type":"CDM"},{"code":"272","type":"RC"},{"code":"41515","type":"LOCAL"},{"code":"157439","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":179.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 41515 = Hospital System Supply Identifier | 157439 = Lawson ID"}]},{"description":"BIT DRILL Q-C 3.5X110MM","code_information":[{"code":"Sx00-4806-110","type":"CDM"},{"code":"272","type":"RC"},{"code":"53312","type":"LOCAL"},{"code":"157440","type":"LOCAL"}],"standard_charges":[{"gross_charge":492.5,"discounted_cash":344.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53312 = Hospital System Supply Identifier | 157440 = Lawson ID"}]},{"description":"BIT DRILL 3.2MM","code_information":[{"code":"Sx00-4806-145","type":"CDM"},{"code":"272","type":"RC"},{"code":"12240","type":"LOCAL"},{"code":"237007","type":"LOCAL"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":267.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12240 = Hospital System Supply Identifier | 237007 = Lawson ID"}]},{"description":"BIT DRILL 4.5X145MM QC VERSA","code_information":[{"code":"Sx00-4806-145","type":"CDM"},{"code":"272","type":"RC"},{"code":"27666","type":"LOCAL"},{"code":"317331","type":"LOCAL"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 27666 = Hospital System Supply Identifier | 317331 = Lawson ID"}]},{"description":"BIT DRILL QC NS REUSE 3.5X195","code_information":[{"code":"Sx00-4806-195","type":"CDM"},{"code":"272","type":"RC"},{"code":"436703","type":"LOCAL"},{"code":"417234","type":"LOCAL"}],"standard_charges":[{"gross_charge":492.5,"discounted_cash":344.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 436703 = Hospital System Supply Identifier | 417234 = Lawson ID"}]},{"description":"BIT DRILL Q/C 3.2X195MM","code_information":[{"code":"Sx00-4806-195","type":"CDM"},{"code":"272","type":"RC"},{"code":"25006","type":"LOCAL"},{"code":"294693","type":"LOCAL"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":267.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 25006 = Hospital System Supply Identifier | 294693 = Lawson ID"}]},{"description":"BIT DRILL Q-C 3-FLUT","code_information":[{"code":"Sx00-4807-180","type":"CDM"},{"code":"272","type":"RC"},{"code":"53313","type":"LOCAL"},{"code":"157441","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":179.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53313 = Hospital System Supply Identifier | 157441 = Lawson ID"}]},{"description":"TAP SURG BONE Q/C 2.7MM SCRW","code_information":[{"code":"Sx00-4811-100","type":"CDM"},{"code":"272","type":"RC"},{"code":"4266","type":"LOCAL"},{"code":"157446","type":"LOCAL"}],"standard_charges":[{"gross_charge":272.15,"discounted_cash":190.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4266 = Hospital System Supply Identifier | 157446 = Lawson ID"}]},{"description":"TAP SURG BONE Q/C 3.5MM SCRW","code_information":[{"code":"Sx00-4811-110","type":"CDM"},{"code":"272","type":"RC"},{"code":"4267","type":"LOCAL"},{"code":"157447","type":"LOCAL"}],"standard_charges":[{"gross_charge":272.15,"discounted_cash":190.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4267 = Hospital System Supply Identifier | 157447 = Lawson ID"}]},{"description":"BIT SCREWDRIVER","code_information":[{"code":"Sx00-4812-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"12233","type":"LOCAL"},{"code":"236996","type":"LOCAL"}],"standard_charges":[{"gross_charge":421.6,"discounted_cash":295.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12233 = Hospital System Supply Identifier | 236996 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X6MM","code_information":[{"code":"Sx00-4815-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5331","type":"LOCAL"},{"code":"345079","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5331 = Hospital System Supply Identifier | 345079 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X6MM","code_information":[{"code":"Sx00-4815-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384093","type":"LOCAL"},{"code":"407448","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384093 = Hospital System Supply Identifier | 407448 = Lawson ID"}]},{"description":"SCREW CORT 1.5X6MM","code_information":[{"code":"Sx00-4815-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383620","type":"LOCAL"},{"code":"398070","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383620 = Hospital System Supply Identifier | 398070 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X7MM","code_information":[{"code":"Sx00-4815-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384094","type":"LOCAL"},{"code":"407449","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384094 = Hospital System Supply Identifier | 407449 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X7MM","code_information":[{"code":"Sx00-4815-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5332","type":"LOCAL"},{"code":"345080","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5332 = Hospital System Supply Identifier | 345080 = Lawson ID"}]},{"description":"SCREW CORT 1.5X7MM","code_information":[{"code":"Sx00-4815-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383621","type":"LOCAL"},{"code":"398071","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383621 = Hospital System Supply Identifier | 398071 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X8MM","code_information":[{"code":"Sx00-4815-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5333","type":"LOCAL"},{"code":"345081","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5333 = Hospital System Supply Identifier | 345081 = Lawson ID"}]},{"description":"SCREW CORT 1.5X8MM","code_information":[{"code":"Sx00-4815-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383622","type":"LOCAL"},{"code":"398072","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383622 = Hospital System Supply Identifier | 398072 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X8MM","code_information":[{"code":"Sx00-4815-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384095","type":"LOCAL"},{"code":"407450","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384095 = Hospital System Supply Identifier | 407450 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X9MM","code_information":[{"code":"Sx00-4815-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1818","type":"LOCAL"},{"code":"339148","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1818 = Hospital System Supply Identifier | 339148 = Lawson ID"}]},{"description":"SCREW CORT 1.5X9MM","code_information":[{"code":"Sx00-4815-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383623","type":"LOCAL"},{"code":"398073","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383623 = Hospital System Supply Identifier | 398073 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X9MM","code_information":[{"code":"Sx00-4815-009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384096","type":"LOCAL"},{"code":"407451","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384096 = Hospital System Supply Identifier | 407451 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X10M","code_information":[{"code":"Sx00-4815-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384097","type":"LOCAL"},{"code":"407452","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384097 = Hospital System Supply Identifier | 407452 = Lawson ID"}]},{"description":"DISC - SCREW CORT 1.5X10MM","code_information":[{"code":"Sx00-4815-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383624","type":"LOCAL"},{"code":"398074","type":"LOCAL"}],"standard_charges":[{"gross_charge":180.5,"discounted_cash":126.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383624 = Hospital System Supply Identifier | 398074 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X10MM","code_information":[{"code":"Sx00-4815-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1819","type":"LOCAL"},{"code":"339149","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1819 = Hospital System Supply Identifier | 339149 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X11MM","code_information":[{"code":"Sx00-4815-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1820","type":"LOCAL"},{"code":"339150","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1820 = Hospital System Supply Identifier | 339150 = Lawson ID"}]},{"description":"SCREW CORT 1.5X11MM","code_information":[{"code":"Sx00-4815-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383625","type":"LOCAL"},{"code":"398075","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383625 = Hospital System Supply Identifier | 398075 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X11M","code_information":[{"code":"Sx00-4815-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384098","type":"LOCAL"},{"code":"407453","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384098 = Hospital System Supply Identifier | 407453 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X12MM","code_information":[{"code":"Sx00-4815-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5334","type":"LOCAL"},{"code":"345082","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5334 = Hospital System Supply Identifier | 345082 = Lawson ID"}]},{"description":"SCREW CORT 1.5X12MM","code_information":[{"code":"Sx00-4815-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383626","type":"LOCAL"},{"code":"398076","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383626 = Hospital System Supply Identifier | 398076 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X12M","code_information":[{"code":"Sx00-4815-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384099","type":"LOCAL"},{"code":"407454","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384099 = Hospital System Supply Identifier | 407454 = Lawson ID"}]},{"description":"SCREW CORT 1.5X14MM","code_information":[{"code":"Sx00-4815-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383627","type":"LOCAL"},{"code":"398077","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383627 = Hospital System Supply Identifier | 398077 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X14M","code_information":[{"code":"Sx00-4815-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384100","type":"LOCAL"},{"code":"407455","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384100 = Hospital System Supply Identifier | 407455 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X14MM","code_information":[{"code":"Sx00-4815-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5335","type":"LOCAL"},{"code":"345083","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5335 = Hospital System Supply Identifier | 345083 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X16MM","code_information":[{"code":"Sx00-4815-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1822","type":"LOCAL"},{"code":"339151","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1822 = Hospital System Supply Identifier | 339151 = Lawson ID"}]},{"description":"SCREW CORT 1.5X16MM","code_information":[{"code":"Sx00-4815-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"383628","type":"LOCAL"},{"code":"398078","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383628 = Hospital System Supply Identifier | 398078 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X16M","code_information":[{"code":"Sx00-4815-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384101","type":"LOCAL"},{"code":"407456","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384101 = Hospital System Supply Identifier | 407456 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X18MM","code_information":[{"code":"Sx00-4815-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1823","type":"LOCAL"},{"code":"339152","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1823 = Hospital System Supply Identifier | 339152 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X18MM","code_information":[{"code":"Sx00-4815-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4996","type":"LOCAL"},{"code":"342351","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4996 = Hospital System Supply Identifier | 342351 = Lawson ID"}]},{"description":"SCREW CORT MINI 1.5X18MM","code_information":[{"code":"Sx00-4815-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384102","type":"LOCAL"},{"code":"407457","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384102 = Hospital System Supply Identifier | 407457 = Lawson ID"}]},{"description":"SCREW CORT MINI 1.5X20MM","code_information":[{"code":"Sx00-4815-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384103","type":"LOCAL"},{"code":"407458","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384103 = Hospital System Supply Identifier | 407458 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X20MM","code_information":[{"code":"Sx00-4815-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4997","type":"LOCAL"},{"code":"342352","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4997 = Hospital System Supply Identifier | 342352 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X20MM","code_information":[{"code":"Sx00-4815-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1824","type":"LOCAL"},{"code":"339153","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1824 = Hospital System Supply Identifier | 339153 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X22MM","code_information":[{"code":"Sx00-4815-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1825","type":"LOCAL"},{"code":"339154","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1825 = Hospital System Supply Identifier | 339154 = Lawson ID"}]},{"description":"SCREW CORT MINI 1.5X22MM","code_information":[{"code":"Sx00-4815-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384104","type":"LOCAL"},{"code":"407459","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384104 = Hospital System Supply Identifier | 407459 = Lawson ID"}]},{"description":"SCREW CORT MINI SLF-TP 1.5X22M","code_information":[{"code":"Sx00-4815-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384105","type":"LOCAL"},{"code":"407460","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384105 = Hospital System Supply Identifier | 407460 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X24MM","code_information":[{"code":"Sx00-4815-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1826","type":"LOCAL"},{"code":"339155","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1826 = Hospital System Supply Identifier | 339155 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 1.5X24MM","code_information":[{"code":"Sx00-4815-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4998","type":"LOCAL"},{"code":"342353","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4998 = Hospital System Supply Identifier | 342353 = Lawson ID"}]},{"description":"SCREW CORT MINI 1.5X24MM","code_information":[{"code":"Sx00-4815-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384106","type":"LOCAL"},{"code":"407461","type":"LOCAL"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384106 = Hospital System Supply Identifier | 407461 = Lawson ID"}]},{"description":"SCREW CORT MINI-FRAG 2.0X16MM","code_information":[{"code":"Sx00-4820-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384113","type":"LOCAL"},{"code":"407468","type":"LOCAL"}],"standard_charges":[{"gross_charge":193.8,"discounted_cash":135.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384113 = Hospital System Supply Identifier | 407468 = Lawson ID"}]},{"description":"BIT DRILL 2.5MM","code_information":[{"code":"Sx00-4836-205","type":"CDM"},{"code":"272","type":"RC"},{"code":"27359","type":"LOCAL"},{"code":"314279","type":"LOCAL"}],"standard_charges":[{"gross_charge":256.1,"discounted_cash":179.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 27359 = Hospital System Supply Identifier | 314279 = Lawson ID"}]},{"description":"IMP HIP ACET AUG SZ50 30","code_information":[{"code":"Sx00-4893-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300679","type":"LOCAL"},{"code":"534888","type":"LOCAL"}],"standard_charges":[{"gross_charge":6845.73,"discounted_cash":4792.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300679 = Hospital System Supply Identifier | 534888 = Lawson ID"}]},{"description":"IMP HIP ACET AUG SZ52 30","code_information":[{"code":"Sx00-4893-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300680","type":"LOCAL"},{"code":"534889","type":"LOCAL"}],"standard_charges":[{"gross_charge":6845.73,"discounted_cash":4792.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300680 = Hospital System Supply Identifier | 534889 = Lawson ID"}]},{"description":"IMP ACET AUG ACET SZ58 20MM","code_information":[{"code":"Sx00-4893-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"2433","type":"LOCAL"},{"code":"340008","type":"LOCAL"}],"standard_charges":[{"gross_charge":6845.73,"discounted_cash":4792.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2433 = Hospital System Supply Identifier | 340008 = Lawson ID"}]},{"description":"IMP HIP ACET AUG SZ58 10","code_information":[{"code":"Sx00-4893-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300681","type":"LOCAL"},{"code":"534890","type":"LOCAL"}],"standard_charges":[{"gross_charge":6845.73,"discounted_cash":4792.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300681 = Hospital System Supply Identifier | 534890 = Lawson ID"}]},{"description":"IMP HIP ACET AUG SZ58 30","code_information":[{"code":"Sx00-4893-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300682","type":"LOCAL"},{"code":"534891","type":"LOCAL"}],"standard_charges":[{"gross_charge":6845.73,"discounted_cash":4792.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300682 = Hospital System Supply Identifier | 534891 = Lawson ID"}]},{"description":"IMP ACET AUG SHIM 5DEG","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"30945","type":"LOCAL"},{"code":"324048","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 30945 = Hospital System Supply Identifier | 324048 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X50MM","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304807","type":"LOCAL"},{"code":"452313","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304807 = Hospital System Supply Identifier | 452313 = Lawson ID"}]},{"description":"IMP ACET AUG SHIM 10D","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300683","type":"LOCAL"},{"code":"534892","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300683 = Hospital System Supply Identifier | 534892 = Lawson ID"}]},{"description":"IMP HIP BTRES AUG STR SZ54","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300684","type":"LOCAL"},{"code":"534893","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300684 = Hospital System Supply Identifier | 534893 = Lawson ID"}]},{"description":"IMP HIP BTRES AUG STR SZ58","code_information":[{"code":"Sx00-4894-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300685","type":"LOCAL"},{"code":"534894","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300685 = Hospital System Supply Identifier | 534894 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 50X30MM","code_information":[{"code":"Sx00-4894-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304304","type":"LOCAL"},{"code":"433896","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304304 = Hospital System Supply Identifier | 433896 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X50MM","code_information":[{"code":"Sx00-4894-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"161217","type":"LOCAL"},{"code":"416867","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 161217 = Hospital System Supply Identifier | 416867 = Lawson ID"}]},{"description":"IMP ACET AUG ACET SZ50 20MM","code_information":[{"code":"Sx00-4894-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"31472","type":"LOCAL"},{"code":"329786","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31472 = Hospital System Supply Identifier | 329786 = Lawson ID"}]},{"description":"IMP ACET AUG ACET SZ50 10MM","code_information":[{"code":"Sx00-4894-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"161086","type":"LOCAL"},{"code":"393661","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 161086 = Hospital System Supply Identifier | 393661 = Lawson ID"}]},{"description":"IMP HIP REV ACET 54MM","code_information":[{"code":"Sx00-4894-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303145","type":"LOCAL"},{"code":"408142","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303145 = Hospital System Supply Identifier | 408142 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X54MM","code_information":[{"code":"Sx00-4894-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303663","type":"LOCAL"},{"code":"416868","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303663 = Hospital System Supply Identifier | 416868 = Lawson ID"}]},{"description":"IMP HIP ACET AUG TM SZ54 20MM","code_information":[{"code":"Sx00-4894-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304799","type":"LOCAL"},{"code":"452305","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304799 = Hospital System Supply Identifier | 452305 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ54 30","code_information":[{"code":"Sx00-4894-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300686","type":"LOCAL"},{"code":"534895","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300686 = Hospital System Supply Identifier | 534895 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ58 30","code_information":[{"code":"Sx00-4894-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300687","type":"LOCAL"},{"code":"534896","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300687 = Hospital System Supply Identifier | 534896 = Lawson ID"}]},{"description":"IMP HIP ACET AUG TM SZ58 20MM","code_information":[{"code":"Sx00-4894-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304800","type":"LOCAL"},{"code":"452306","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304800 = Hospital System Supply Identifier | 452306 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X58MM","code_information":[{"code":"Sx00-4894-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304192","type":"LOCAL"},{"code":"428862","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304192 = Hospital System Supply Identifier | 428862 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 10X58MM","code_information":[{"code":"Sx00-4894-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"192736","type":"LOCAL"},{"code":"416869","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 192736 = Hospital System Supply Identifier | 416869 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 10X62MM","code_information":[{"code":"Sx00-4894-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303664","type":"LOCAL"},{"code":"416870","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303664 = Hospital System Supply Identifier | 416870 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 20X66MM","code_information":[{"code":"Sx00-4894-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303665","type":"LOCAL"},{"code":"416871","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303665 = Hospital System Supply Identifier | 416871 = Lawson ID"}]},{"description":"IMP HIP ACET AUG TM SZ62 15MM","code_information":[{"code":"Sx00-4894-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304801","type":"LOCAL"},{"code":"452307","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304801 = Hospital System Supply Identifier | 452307 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ62 30","code_information":[{"code":"Sx00-4894-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300688","type":"LOCAL"},{"code":"534897","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300688 = Hospital System Supply Identifier | 534897 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ66 20","code_information":[{"code":"Sx00-4894-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300689","type":"LOCAL"},{"code":"534898","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300689 = Hospital System Supply Identifier | 534898 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ66 30","code_information":[{"code":"Sx00-4894-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300690","type":"LOCAL"},{"code":"534899","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300690 = Hospital System Supply Identifier | 534899 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 10X66MM","code_information":[{"code":"Sx00-4894-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303666","type":"LOCAL"},{"code":"416872","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303666 = Hospital System Supply Identifier | 416872 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG 15X66MM","code_information":[{"code":"Sx00-4894-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303667","type":"LOCAL"},{"code":"416873","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303667 = Hospital System Supply Identifier | 416873 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ70 10","code_information":[{"code":"Sx00-4894-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300691","type":"LOCAL"},{"code":"534900","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300691 = Hospital System Supply Identifier | 534900 = Lawson ID"}]},{"description":"IMP HIP ACET REV AUG SZ70 15","code_information":[{"code":"Sx00-4894-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300692","type":"LOCAL"},{"code":"534901","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300692 = Hospital System Supply Identifier | 534901 = Lawson ID"}]},{"description":"IMP HIP BTRES AUG LT POST RT","code_information":[{"code":"Sx00-4894-300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300693","type":"LOCAL"},{"code":"534902","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300693 = Hospital System Supply Identifier | 534902 = Lawson ID"}]},{"description":"BUTTRESS COLUMN REV RT POST LT","code_information":[{"code":"Sx00-4894-400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304205","type":"LOCAL"},{"code":"432039","type":"LOCAL"}],"standard_charges":[{"gross_charge":5355.0,"discounted_cash":3748.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304205 = Hospital System Supply Identifier | 432039 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 37 7H LT","code_information":[{"code":"Sx00-4915-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384423","type":"LOCAL"},{"code":"410451","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.01,"discounted_cash":767.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384423 = Hospital System Supply Identifier | 410451 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 37 7H RT","code_information":[{"code":"Sx00-4915-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384424","type":"LOCAL"},{"code":"410452","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.01,"discounted_cash":767.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384424 = Hospital System Supply Identifier | 410452 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 1.5 20H","code_information":[{"code":"Sx00-4915-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4932","type":"LOCAL"},{"code":"342129","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.01,"discounted_cash":767.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4932 = Hospital System Supply Identifier | 342129 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 49MM 3H/9H","code_information":[{"code":"Sx00-4915-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384425","type":"LOCAL"},{"code":"410453","type":"LOCAL"}],"standard_charges":[{"gross_charge":641.25,"discounted_cash":448.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384425 = Hospital System Supply Identifier | 410453 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 49MM 4H/9H","code_information":[{"code":"Sx00-4915-049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384426","type":"LOCAL"},{"code":"410454","type":"LOCAL"}],"standard_charges":[{"gross_charge":666.9,"discounted_cash":466.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384426 = Hospital System Supply Identifier | 410454 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 2.0 LT","code_information":[{"code":"Sx00-4920-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2434","type":"LOCAL"},{"code":"340009","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.01,"discounted_cash":767.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2434 = Hospital System Supply Identifier | 340009 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 2.0 RT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2445","type":"LOCAL"},{"code":"340014","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.01,"discounted_cash":767.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2445 = Hospital System Supply Identifier | 340014 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 2.0 18MM","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5373","type":"LOCAL"},{"code":"345121","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.25,"discounted_cash":310.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5373 = Hospital System Supply Identifier | 345121 = Lawson ID"}]},{"description":"PLATE MINI FRAG L OBLQ 2.0 RT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2438","type":"LOCAL"},{"code":"340013","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.25,"discounted_cash":310.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2438 = Hospital System Supply Identifier | 340013 = Lawson ID"}]},{"description":"PLATE MINI FRAG L OBLQ 2.0 LT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2437","type":"LOCAL"},{"code":"340012","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.25,"discounted_cash":310.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2437 = Hospital System Supply Identifier | 340012 = Lawson ID"}]},{"description":"PLATE MINI FRAG L 2.0 18MM RT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2436","type":"LOCAL"},{"code":"340011","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.25,"discounted_cash":310.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2436 = Hospital System Supply Identifier | 340011 = Lawson ID"}]},{"description":"PLATE MINI FRAG L 2.0 18MM LT","code_information":[{"code":"Sx00-4920-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2435","type":"LOCAL"},{"code":"340010","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.25,"discounted_cash":310.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2435 = Hospital System Supply Identifier | 340010 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 2.0 3H 17M","code_information":[{"code":"Sx00-4920-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5374","type":"LOCAL"},{"code":"345122","type":"LOCAL"}],"standard_charges":[{"gross_charge":689.5,"discounted_cash":482.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5374 = Hospital System Supply Identifier | 345122 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 4H","code_information":[{"code":"Sx00-4920-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1905","type":"LOCAL"},{"code":"339189","type":"LOCAL"}],"standard_charges":[{"gross_charge":1247.0,"discounted_cash":872.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1905 = Hospital System Supply Identifier | 339189 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 4.0 3H 23M","code_information":[{"code":"Sx00-4920-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1906","type":"LOCAL"},{"code":"339190","type":"LOCAL"}],"standard_charges":[{"gross_charge":738.75,"discounted_cash":517.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1906 = Hospital System Supply Identifier | 339190 = Lawson ID"}]},{"description":"PLATE MINI FRAG H 2.0 4H 12MM","code_information":[{"code":"Sx00-4920-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4933","type":"LOCAL"},{"code":"342130","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.86,"discounted_cash":640.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4933 = Hospital System Supply Identifier | 342130 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 5H","code_information":[{"code":"Sx00-4920-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1907","type":"LOCAL"},{"code":"339191","type":"LOCAL"}],"standard_charges":[{"gross_charge":1247.0,"discounted_cash":872.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1907 = Hospital System Supply Identifier | 339191 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 2.0 5H 29M","code_information":[{"code":"Sx00-4920-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5375","type":"LOCAL"},{"code":"345123","type":"LOCAL"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":551.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5375 = Hospital System Supply Identifier | 345123 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 2.0 6H 35M","code_information":[{"code":"Sx00-4920-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5376","type":"LOCAL"},{"code":"345124","type":"LOCAL"}],"standard_charges":[{"gross_charge":837.25,"discounted_cash":586.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5376 = Hospital System Supply Identifier | 345124 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 6H","code_information":[{"code":"Sx00-4920-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1908","type":"LOCAL"},{"code":"339192","type":"LOCAL"}],"standard_charges":[{"gross_charge":1247.0,"discounted_cash":872.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1908 = Hospital System Supply Identifier | 339192 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 7H","code_information":[{"code":"Sx00-4920-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1909","type":"LOCAL"},{"code":"339193","type":"LOCAL"}],"standard_charges":[{"gross_charge":1247.0,"discounted_cash":872.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1909 = Hospital System Supply Identifier | 339193 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 8H","code_information":[{"code":"Sx00-4920-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2446","type":"LOCAL"},{"code":"340015","type":"LOCAL"}],"standard_charges":[{"gross_charge":1247.0,"discounted_cash":872.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2446 = Hospital System Supply Identifier | 340015 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 10H","code_information":[{"code":"Sx00-4920-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2447","type":"LOCAL"},{"code":"340016","type":"LOCAL"}],"standard_charges":[{"gross_charge":1247.0,"discounted_cash":872.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2447 = Hospital System Supply Identifier | 340016 = Lawson ID"}]},{"description":"PLATE MINI FRAG COMPR 2.0 12H","code_information":[{"code":"Sx00-4920-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2448","type":"LOCAL"},{"code":"340017","type":"LOCAL"}],"standard_charges":[{"gross_charge":1247.0,"discounted_cash":872.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2448 = Hospital System Supply Identifier | 340017 = Lawson ID"}]},{"description":"PLATE MINI FRAG STR 20H 100MM","code_information":[{"code":"Sx00-4920-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2450","type":"LOCAL"},{"code":"340018","type":"LOCAL"}],"standard_charges":[{"gross_charge":1097.01,"discounted_cash":767.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2450 = Hospital System Supply Identifier | 340018 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 2.0 3H HD 9H","code_information":[{"code":"Sx00-4920-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2451","type":"LOCAL"},{"code":"340019","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.86,"discounted_cash":640.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2451 = Hospital System Supply Identifier | 340019 = Lawson ID"}]},{"description":"PLATE MINI FRAG T 2.0 4H HD 9H","code_information":[{"code":"Sx00-4920-049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2452","type":"LOCAL"},{"code":"340020","type":"LOCAL"}],"standard_charges":[{"gross_charge":914.86,"discounted_cash":640.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2452 = Hospital System Supply Identifier | 340020 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 2.7 LT","code_information":[{"code":"Sx00-4927-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2454","type":"LOCAL"},{"code":"340022","type":"LOCAL"}],"standard_charges":[{"gross_charge":884.95,"discounted_cash":619.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2454 = Hospital System Supply Identifier | 340022 = Lawson ID"}]},{"description":"PLATE BONE 4 HOLE CONDYLAR LEFT 00492700119 STAINLESS STEEL 2..7X57MM","code_information":[{"code":"Sx00-4927-001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1103213","type":"LOCAL"},{"code":"1062919","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.37,"discounted_cash":797.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1103213 = Hospital System Supply Identifier | 1062919 = Lawson ID"}]},{"description":"PLATE BONE 4 HOLE CONDYLAR RIGHT 00492700219 STAINLESS STEEL 2.7X57MM","code_information":[{"code":"Sx00-4927-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1103214","type":"LOCAL"},{"code":"1062862","type":"LOCAL"}],"standard_charges":[{"gross_charge":1139.37,"discounted_cash":797.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1103214 = Hospital System Supply Identifier | 1062862 = Lawson ID"}]},{"description":"PLATE MINI FRAG CNDYL 2.7 RT","code_information":[{"code":"Sx00-4927-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2456","type":"LOCAL"},{"code":"340024","type":"LOCAL"}],"standard_charges":[{"gross_charge":884.95,"discounted_cash":619.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2456 = Hospital System Supply Identifier | 340024 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 3H","code_information":[{"code":"Sx00-4927-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5377","type":"LOCAL"},{"code":"345125","type":"LOCAL"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":551.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5377 = Hospital System Supply Identifier | 345125 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 4H","code_information":[{"code":"Sx00-4927-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5378","type":"LOCAL"},{"code":"345126","type":"LOCAL"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":551.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5378 = Hospital System Supply Identifier | 345126 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 5H","code_information":[{"code":"Sx00-4927-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5379","type":"LOCAL"},{"code":"345127","type":"LOCAL"}],"standard_charges":[{"gross_charge":886.5,"discounted_cash":620.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5379 = Hospital System Supply Identifier | 345127 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 6H","code_information":[{"code":"Sx00-4927-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31898","type":"LOCAL"},{"code":"332731","type":"LOCAL"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":689.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31898 = Hospital System Supply Identifier | 332731 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 7H","code_information":[{"code":"Sx00-4927-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5380","type":"LOCAL"},{"code":"345128","type":"LOCAL"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":689.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5380 = Hospital System Supply Identifier | 345128 = Lawson ID"}]},{"description":"PLATE MINI FRAG MLT 2.7 7H","code_information":[{"code":"Sx00-4927-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"2464","type":"LOCAL"},{"code":"340031","type":"LOCAL"}],"standard_charges":[{"gross_charge":443.55,"discounted_cash":310.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2464 = Hospital System Supply Identifier | 340031 = Lawson ID"}]},{"description":"PLATE MINI FRAG 1/4 TBLR 8H","code_information":[{"code":"Sx00-4927-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"5381","type":"LOCAL"},{"code":"345129","type":"LOCAL"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":689.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5381 = Hospital System Supply Identifier | 345129 = Lawson ID"}]},{"description":"PLATE SM FRAG COMPR 2H 25MM","code_information":[{"code":"Sx00-4935-002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384456","type":"LOCAL"},{"code":"410486","type":"LOCAL"}],"standard_charges":[{"gross_charge":371.95,"discounted_cash":260.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384456 = Hospital System Supply Identifier | 410486 = Lawson ID"}]},{"description":"PLATE SM FRAG CLVRLF 3.5 3H","code_information":[{"code":"Sx00-4935-003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"1954","type":"LOCAL"},{"code":"339257","type":"LOCAL"}],"standard_charges":[{"gross_charge":384.75,"discounted_cash":269.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1954 = Hospital System Supply Identifier | 339257 = Lawson ID"}]},{"description":"PLATE SM FRAG 3.5MM 4H 49MM","code_information":[{"code":"Sx00-4935-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"37707","type":"LOCAL"},{"code":"216791","type":"LOCAL"}],"standard_charges":[{"gross_charge":397.6,"discounted_cash":278.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37707 = Hospital System Supply Identifier | 216791 = Lawson ID"}]},{"description":"PLATE SM FRAG 3.5MM 5H 61MM","code_information":[{"code":"Sx00-4935-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"37708","type":"LOCAL"},{"code":"216792","type":"LOCAL"}],"standard_charges":[{"gross_charge":410.4,"discounted_cash":287.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37708 = Hospital System Supply Identifier | 216792 = Lawson ID"}]},{"description":"PLATE SM FRAG CLVRLF 120MM 5H","code_information":[{"code":"Sx00-4935-005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384457","type":"LOCAL"},{"code":"410490","type":"LOCAL"}],"standard_charges":[{"gross_charge":992.65,"discounted_cash":694.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384457 = Hospital System Supply Identifier | 410490 = Lawson ID"}]},{"description":"PLATE SM FRAG CLVRLF 3.5 6H","code_information":[{"code":"Sx00-4935-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4928","type":"LOCAL"},{"code":"342118","type":"LOCAL"}],"standard_charges":[{"gross_charge":1080.89,"discounted_cash":756.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4928 = Hospital System Supply Identifier | 342118 = Lawson ID"}]},{"description":"PLATE SM FRAG CLVRLF 152MM 7H","code_information":[{"code":"Sx00-4935-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384458","type":"LOCAL"},{"code":"410491","type":"LOCAL"}],"standard_charges":[{"gross_charge":1147.06,"discounted_cash":802.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384458 = Hospital System Supply Identifier | 410491 = Lawson ID"}]},{"description":"PLATE SM FRAG CLVRLF 168MM 8H","code_information":[{"code":"Sx00-4935-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384459","type":"LOCAL"},{"code":"410492","type":"LOCAL"}],"standard_charges":[{"gross_charge":1224.29,"discounted_cash":857.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384459 = Hospital System Supply Identifier | 410492 = Lawson ID"}]},{"description":"PLATE SM FRAG CLVRLF 200MM 10H","code_information":[{"code":"Sx00-4935-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384460","type":"LOCAL"},{"code":"410493","type":"LOCAL"}],"standard_charges":[{"gross_charge":1323.54,"discounted_cash":926.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384460 = Hospital System Supply Identifier | 410493 = Lawson ID"}]},{"description":"PLATE SM FRAG 3.5MM 12H 145MM","code_information":[{"code":"Sx00-4935-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"37714","type":"LOCAL"},{"code":"216798","type":"LOCAL"}],"standard_charges":[{"gross_charge":564.3,"discounted_cash":395.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37714 = Hospital System Supply Identifier | 216798 = Lawson ID"}]},{"description":"PLATE CNTR 2COMPR 169MM 14H","code_information":[{"code":"Sx00-4935-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384461","type":"LOCAL"},{"code":"410495","type":"LOCAL"}],"standard_charges":[{"gross_charge":882.36,"discounted_cash":617.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384461 = Hospital System Supply Identifier | 410495 = Lawson ID"}]},{"description":"PLATE SM FRAG COMPR 194MM 16H","code_information":[{"code":"Sx00-4935-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384462","type":"LOCAL"},{"code":"410497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1014.71,"discounted_cash":710.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384462 = Hospital System Supply Identifier | 410497 = Lawson ID"}]},{"description":"PLATE SM FRAG COMPR 217MM 18H","code_information":[{"code":"Sx00-4935-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384463","type":"LOCAL"},{"code":"410498","type":"LOCAL"}],"standard_charges":[{"gross_charge":1136.06,"discounted_cash":795.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384463 = Hospital System Supply Identifier | 410498 = Lawson ID"}]},{"description":"PLATE SM FRAG COMPR 242MM 20H","code_information":[{"code":"Sx00-4935-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384464","type":"LOCAL"},{"code":"410499","type":"LOCAL"}],"standard_charges":[{"gross_charge":1246.35,"discounted_cash":872.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384464 = Hospital System Supply Identifier | 410499 = Lawson ID"}]},{"description":"PLATE COMPR SM FRAG 22H","code_information":[{"code":"Sx00-4935-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384662","type":"LOCAL"},{"code":"418237","type":"LOCAL"}],"standard_charges":[{"gross_charge":1345.59,"discounted_cash":941.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384662 = Hospital System Supply Identifier | 418237 = Lawson ID"}]},{"description":"PLATE SM FRAG T OBLQ 3.5 3X4H","code_information":[{"code":"Sx00-4935-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"31904","type":"LOCAL"},{"code":"332737","type":"LOCAL"}],"standard_charges":[{"gross_charge":654.1,"discounted_cash":457.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 31904 = Hospital System Supply Identifier | 332737 = Lawson ID"}]},{"description":"PLATE SM FRAG T 3.5 3X5H","code_information":[{"code":"Sx00-4935-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"37716","type":"LOCAL"},{"code":"216800","type":"LOCAL"}],"standard_charges":[{"gross_charge":436.05,"discounted_cash":305.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 37716 = Hospital System Supply Identifier | 216800 = Lawson ID"}]},{"description":"PLATE SM FRAG T 3.5 4X6H","code_information":[{"code":"Sx00-4935-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4959","type":"LOCAL"},{"code":"342174","type":"LOCAL"}],"standard_charges":[{"gross_charge":500.2,"discounted_cash":350.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4959 = Hospital System Supply Identifier | 342174 = Lawson ID"}]},{"description":"PLATE SM FRAG T 3.5 4X7H","code_information":[{"code":"Sx00-4935-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"4960","type":"LOCAL"},{"code":"342175","type":"LOCAL"}],"standard_charges":[{"gross_charge":615.6,"discounted_cash":430.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 4960 = Hospital System Supply Identifier | 342175 = Lawson ID"}]},{"description":"PLATE SM FRAG T 3.5 4X8H","code_information":[{"code":"Sx00-4935-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384337","type":"LOCAL"},{"code":"409652","type":"LOCAL"}],"standard_charges":[{"gross_charge":692.55,"discounted_cash":484.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384337 = Hospital System Supply Identifier | 409652 = Lawson ID"}]},{"description":"PLATE SM FRAG CALCNL 60MM 15H","code_information":[{"code":"Sx00-4935-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384465","type":"LOCAL"},{"code":"410501","type":"LOCAL"}],"standard_charges":[{"gross_charge":1279.42,"discounted_cash":895.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384465 = Hospital System Supply Identifier | 410501 = Lawson ID"}]},{"description":"PLATE SM FRAG CALCNL 70MM 15H","code_information":[{"code":"Sx00-4935-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384466","type":"LOCAL"},{"code":"410502","type":"LOCAL"}],"standard_charges":[{"gross_charge":1290.47,"discounted_cash":903.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384466 = Hospital System Supply Identifier | 410502 = Lawson ID"}]},{"description":"PLATE SM FRAG Y 87MM 4X9H","code_information":[{"code":"Sx00-4935-087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384467","type":"LOCAL"},{"code":"410503","type":"LOCAL"}],"standard_charges":[{"gross_charge":1290.47,"discounted_cash":903.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384467 = Hospital System Supply Identifier | 410503 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 38MM","code_information":[{"code":"Sx00-5001-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280065","type":"LOCAL"},{"code":"522124","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280065 = Hospital System Supply Identifier | 522124 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 38X22MM","code_information":[{"code":"Sx00-5001-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280066","type":"LOCAL"},{"code":"522125","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280066 = Hospital System Supply Identifier | 522125 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 39MM","code_information":[{"code":"Sx00-5001-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280067","type":"LOCAL"},{"code":"522126","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280067 = Hospital System Supply Identifier | 522126 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 39X22MM","code_information":[{"code":"Sx00-5001-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280068","type":"LOCAL"},{"code":"522127","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280068 = Hospital System Supply Identifier | 522127 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-40","code_information":[{"code":"Sx00-5001-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134319","type":"LOCAL"},{"code":"208810","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134319 = Hospital System Supply Identifier | 208810 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-40-22","code_information":[{"code":"Sx00-5001-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53440","type":"LOCAL"},{"code":"208831","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53440 = Hospital System Supply Identifier | 208831 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 40X26MM","code_information":[{"code":"Sx00-5001-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280069","type":"LOCAL"},{"code":"522128","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280069 = Hospital System Supply Identifier | 522128 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-41","code_information":[{"code":"Sx00-5001-041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53413","type":"LOCAL"},{"code":"208811","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53413 = Hospital System Supply Identifier | 208811 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-42","code_information":[{"code":"Sx00-5001-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134320","type":"LOCAL"},{"code":"208812","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134320 = Hospital System Supply Identifier | 208812 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-42-22","code_information":[{"code":"Sx00-5001-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134333","type":"LOCAL"},{"code":"208832","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134333 = Hospital System Supply Identifier | 208832 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 42X26MM","code_information":[{"code":"Sx00-5001-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280070","type":"LOCAL"},{"code":"522129","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280070 = Hospital System Supply Identifier | 522129 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-43","code_information":[{"code":"Sx00-5001-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134321","type":"LOCAL"},{"code":"208813","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134321 = Hospital System Supply Identifier | 208813 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-44","code_information":[{"code":"Sx00-5001-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53414","type":"LOCAL"},{"code":"208814","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53414 = Hospital System Supply Identifier | 208814 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-44-28","code_information":[{"code":"Sx00-5001-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53441","type":"LOCAL"},{"code":"208833","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53441 = Hospital System Supply Identifier | 208833 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 44X22MM","code_information":[{"code":"Sx00-5001-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280071","type":"LOCAL"},{"code":"522130","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280071 = Hospital System Supply Identifier | 522130 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 44X26MM","code_information":[{"code":"Sx00-5001-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280072","type":"LOCAL"},{"code":"522131","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280072 = Hospital System Supply Identifier | 522131 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-45","code_information":[{"code":"Sx00-5001-045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53437","type":"LOCAL"},{"code":"208815","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53437 = Hospital System Supply Identifier | 208815 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-46","code_information":[{"code":"Sx00-5001-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134322","type":"LOCAL"},{"code":"208816","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134322 = Hospital System Supply Identifier | 208816 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-47","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134323","type":"LOCAL"},{"code":"208817","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134323 = Hospital System Supply Identifier | 208817 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-47-28","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53442","type":"LOCAL"},{"code":"208834","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53442 = Hospital System Supply Identifier | 208834 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 47X22MM","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280073","type":"LOCAL"},{"code":"522132","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280073 = Hospital System Supply Identifier | 522132 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 47X26MM","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280074","type":"LOCAL"},{"code":"522133","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280074 = Hospital System Supply Identifier | 522133 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 47X32MM","code_information":[{"code":"Sx00-5001-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280075","type":"LOCAL"},{"code":"522134","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280075 = Hospital System Supply Identifier | 522134 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-48","code_information":[{"code":"Sx00-5001-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134324","type":"LOCAL"},{"code":"208818","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134324 = Hospital System Supply Identifier | 208818 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-49","code_information":[{"code":"Sx00-5001-049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53438","type":"LOCAL"},{"code":"208819","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53438 = Hospital System Supply Identifier | 208819 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 50X32MM","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280078","type":"LOCAL"},{"code":"522137","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280078 = Hospital System Supply Identifier | 522137 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 50X22MM","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280076","type":"LOCAL"},{"code":"522135","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280076 = Hospital System Supply Identifier | 522135 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 50X26MM","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280077","type":"LOCAL"},{"code":"522136","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280077 = Hospital System Supply Identifier | 522136 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-50-28","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134334","type":"LOCAL"},{"code":"208835","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134334 = Hospital System Supply Identifier | 208835 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-50","code_information":[{"code":"Sx00-5001-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134325","type":"LOCAL"},{"code":"208820","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134325 = Hospital System Supply Identifier | 208820 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-51","code_information":[{"code":"Sx00-5001-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134326","type":"LOCAL"},{"code":"208821","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134326 = Hospital System Supply Identifier | 208821 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-52","code_information":[{"code":"Sx00-5001-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134327","type":"LOCAL"},{"code":"208822","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134327 = Hospital System Supply Identifier | 208822 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-53","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134328","type":"LOCAL"},{"code":"208823","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134328 = Hospital System Supply Identifier | 208823 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-53-28","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53443","type":"LOCAL"},{"code":"208836","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53443 = Hospital System Supply Identifier | 208836 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 53X22MM","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280079","type":"LOCAL"},{"code":"522138","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280079 = Hospital System Supply Identifier | 522138 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 53X26MM","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280080","type":"LOCAL"},{"code":"522139","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280080 = Hospital System Supply Identifier | 522139 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 53X32MM","code_information":[{"code":"Sx00-5001-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280081","type":"LOCAL"},{"code":"522140","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280081 = Hospital System Supply Identifier | 522140 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-54","code_information":[{"code":"Sx00-5001-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134329","type":"LOCAL"},{"code":"208824","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134329 = Hospital System Supply Identifier | 208824 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-55","code_information":[{"code":"Sx00-5001-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53439","type":"LOCAL"},{"code":"208825","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 53439 = Hospital System Supply Identifier | 208825 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-57","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134330","type":"LOCAL"},{"code":"208826","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134330 = Hospital System Supply Identifier | 208826 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-57-28","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134335","type":"LOCAL"},{"code":"208837","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134335 = Hospital System Supply Identifier | 208837 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 57X22MM","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280082","type":"LOCAL"},{"code":"522141","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280082 = Hospital System Supply Identifier | 522141 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 57X26MM","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280083","type":"LOCAL"},{"code":"522142","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280083 = Hospital System Supply Identifier | 522142 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 57X32MM","code_information":[{"code":"Sx00-5001-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280084","type":"LOCAL"},{"code":"522143","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280084 = Hospital System Supply Identifier | 522143 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTIPOLAR","code_information":[{"code":"Sx00-5001-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134331","type":"LOCAL"},{"code":"208827","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134331 = Hospital System Supply Identifier | 208827 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X32MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280087","type":"LOCAL"},{"code":"522146","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280087 = Hospital System Supply Identifier | 522146 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X26MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280086","type":"LOCAL"},{"code":"522145","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280086 = Hospital System Supply Identifier | 522145 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X22MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280085","type":"LOCAL"},{"code":"522144","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280085 = Hospital System Supply Identifier | 522144 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-60-28","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134336","type":"LOCAL"},{"code":"208838","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134336 = Hospital System Supply Identifier | 208838 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-60","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134332","type":"LOCAL"},{"code":"208828","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 134332 = Hospital System Supply Identifier | 208828 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-62","code_information":[{"code":"Sx00-5001-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"185007","type":"LOCAL"},{"code":"208829","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 185007 = Hospital System Supply Identifier | 208829 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-64","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302265","type":"LOCAL"},{"code":"208830","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 302265 = Hospital System Supply Identifier | 208830 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 5001-64-28","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305497","type":"LOCAL"},{"code":"208839","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305497 = Hospital System Supply Identifier | 208839 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 64X26MM","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280088","type":"LOCAL"},{"code":"522147","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280088 = Hospital System Supply Identifier | 522147 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 64X32MM","code_information":[{"code":"Sx00-5001-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280089","type":"LOCAL"},{"code":"522148","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280089 = Hospital System Supply Identifier | 522148 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 66MM","code_information":[{"code":"Sx00-5001-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280090","type":"LOCAL"},{"code":"522149","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280090 = Hospital System Supply Identifier | 522149 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 68X32MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280093","type":"LOCAL"},{"code":"522152","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280093 = Hospital System Supply Identifier | 522152 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 68X26MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280092","type":"LOCAL"},{"code":"522151","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280092 = Hospital System Supply Identifier | 522151 = 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":"280091","type":"LOCAL"},{"code":"522150","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280091 = Hospital System Supply Identifier | 522150 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTPLR 68-70","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303146","type":"LOCAL"},{"code":"408143","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303146 = Hospital System Supply Identifier | 408143 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 70MM","code_information":[{"code":"Sx00-5001-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280094","type":"LOCAL"},{"code":"522153","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280094 = 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":"303147","type":"LOCAL"},{"code":"408144","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303147 = 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":"280095","type":"LOCAL"},{"code":"522154","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280095 = 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":"280096","type":"LOCAL"},{"code":"522155","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280096 = Hospital System Supply Identifier | 522155 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 72X32MM","code_information":[{"code":"Sx00-5001-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280097","type":"LOCAL"},{"code":"522156","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280097 = Hospital System Supply Identifier | 522156 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 22 38-43MM","code_information":[{"code":"Sx00-5003-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"26951","type":"LOCAL"},{"code":"310982","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 26951 = Hospital System Supply Identifier | 310982 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 44-49MM","code_information":[{"code":"Sx00-5003-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"26952","type":"LOCAL"},{"code":"310983","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 26952 = Hospital System Supply Identifier | 310983 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 50-58MM","code_information":[{"code":"Sx00-5003-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"26953","type":"LOCAL"},{"code":"310984","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 26953 = Hospital System Supply Identifier | 310984 = Lawson ID"}]},{"description":"IMP HIP LNR PRVSNL 28 60-72MM","code_information":[{"code":"Sx00-5003-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"26950","type":"LOCAL"},{"code":"310981","type":"LOCAL"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 26950 = Hospital System Supply Identifier | 310981 = Lawson ID"}]},{"description":"BLADE MICRO MILL 19 204","code_information":[{"code":"Sx00-5052-204","type":"CDM"},{"code":"272","type":"RC"},{"code":"144389","type":"LOCAL"},{"code":"100437","type":"LOCAL"}],"standard_charges":[{"gross_charge":482.4,"discounted_cash":337.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 144389 = Hospital System Supply Identifier | 100437 = Lawson ID"}]},{"description":"NO USAGE - BUR OTOTOME 5.0X48 CARB 144","code_information":[{"code":"Sx00-5056-144","type":"CDM"},{"code":"272","type":"RC"},{"code":"59942","type":"LOCAL"},{"code":"100568","type":"LOCAL"}],"standard_charges":[{"gross_charge":441.8,"discounted_cash":309.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 59942 = Hospital System Supply Identifier | 100568 = Lawson ID"}]},{"description":"PIN HEX HD HLDNG","code_information":[{"code":"Sx00-5061-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"12394","type":"LOCAL"},{"code":"237595","type":"LOCAL"}],"standard_charges":[{"gross_charge":142.78,"discounted_cash":99.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12394 = Hospital System Supply Identifier | 237595 = Lawson ID"}]},{"description":"SYSTEM BONE CEMENT NSTRL REMOV","code_information":[{"code":"Sx00-5061-084","type":"CDM"},{"code":"272","type":"RC"},{"code":"889398","type":"LOCAL"},{"code":"816445","type":"LOCAL"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 889398 = Hospital System Supply Identifier | 816445 = Lawson ID"}]},{"description":"BLADE EXTRACTOR EXODUS HIP STEM REMOVAL 0051040000","code_information":[{"code":"Sx00-510-400-","type":"CDM"},{"code":"272","type":"RC"},{"code":"1026197","type":"LOCAL"},{"code":"1008181","type":"LOCAL"}],"standard_charges":[{"gross_charge":4812.67,"discounted_cash":3368.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1026197 = Hospital System Supply Identifier | 1008181 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ2","code_information":[{"code":"Sx00-5110-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300732","type":"LOCAL"},{"code":"534941","type":"LOCAL"}],"standard_charges":[{"gross_charge":21710.18,"discounted_cash":15197.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300732 = Hospital System Supply Identifier | 534941 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ2","code_information":[{"code":"Sx00-5110-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300733","type":"LOCAL"},{"code":"534942","type":"LOCAL"}],"standard_charges":[{"gross_charge":21710.18,"discounted_cash":15197.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300733 = Hospital System Supply Identifier | 534942 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ3","code_information":[{"code":"Sx00-5110-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300734","type":"LOCAL"},{"code":"534943","type":"LOCAL"}],"standard_charges":[{"gross_charge":21710.18,"discounted_cash":15197.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300734 = Hospital System Supply Identifier | 534943 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ3","code_information":[{"code":"Sx00-5110-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300735","type":"LOCAL"},{"code":"534944","type":"LOCAL"}],"standard_charges":[{"gross_charge":21710.18,"discounted_cash":15197.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300735 = Hospital System Supply Identifier | 534944 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ4","code_information":[{"code":"Sx00-5110-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300737","type":"LOCAL"},{"code":"534946","type":"LOCAL"}],"standard_charges":[{"gross_charge":21710.18,"discounted_cash":15197.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300737 = Hospital System Supply Identifier | 534946 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ4","code_information":[{"code":"Sx00-5110-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300736","type":"LOCAL"},{"code":"534945","type":"LOCAL"}],"standard_charges":[{"gross_charge":21710.18,"discounted_cash":15197.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300736 = Hospital System Supply Identifier | 534945 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ5","code_information":[{"code":"Sx00-5110-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"30966","type":"LOCAL"},{"code":"324071","type":"LOCAL"}],"standard_charges":[{"gross_charge":21710.18,"discounted_cash":15197.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 30966 = Hospital System Supply Identifier | 324071 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ5","code_information":[{"code":"Sx00-5110-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300738","type":"LOCAL"},{"code":"534947","type":"LOCAL"}],"standard_charges":[{"gross_charge":21710.18,"discounted_cash":15197.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300738 = Hospital System Supply Identifier | 534947 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ6","code_information":[{"code":"Sx00-5110-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300739","type":"LOCAL"},{"code":"534948","type":"LOCAL"}],"standard_charges":[{"gross_charge":21710.18,"discounted_cash":15197.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300739 = Hospital System Supply Identifier | 534948 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ6","code_information":[{"code":"Sx00-5110-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300740","type":"LOCAL"},{"code":"534949","type":"LOCAL"}],"standard_charges":[{"gross_charge":21710.18,"discounted_cash":15197.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300740 = Hospital System Supply Identifier | 534949 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ7","code_information":[{"code":"Sx00-5110-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300741","type":"LOCAL"},{"code":"534950","type":"LOCAL"}],"standard_charges":[{"gross_charge":21710.18,"discounted_cash":15197.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300741 = Hospital System Supply Identifier | 534950 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ7","code_information":[{"code":"Sx00-5110-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300742","type":"LOCAL"},{"code":"534951","type":"LOCAL"}],"standard_charges":[{"gross_charge":21710.18,"discounted_cash":15197.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300742 = Hospital System Supply Identifier | 534951 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 23","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300749","type":"LOCAL"},{"code":"534958","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300749 = Hospital System Supply Identifier | 534958 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 20","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300748","type":"LOCAL"},{"code":"534957","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300748 = Hospital System Supply Identifier | 534957 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 17","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300747","type":"LOCAL"},{"code":"534956","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300747 = Hospital System Supply Identifier | 534956 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A/B 9","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300743","type":"LOCAL"},{"code":"534952","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300743 = Hospital System Supply Identifier | 534952 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 13","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300745","type":"LOCAL"},{"code":"534954","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300745 = Hospital System Supply Identifier | 534954 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII AB 11","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300744","type":"LOCAL"},{"code":"534953","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300744 = Hospital System Supply Identifier | 534953 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII A B 15","code_information":[{"code":"Sx00-5110-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300746","type":"LOCAL"},{"code":"534955","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300746 = Hospital System Supply Identifier | 534955 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 11","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300750","type":"LOCAL"},{"code":"534959","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300750 = Hospital System Supply Identifier | 534959 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 13","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300751","type":"LOCAL"},{"code":"534960","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300751 = Hospital System Supply Identifier | 534960 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 15","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300752","type":"LOCAL"},{"code":"534961","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300752 = Hospital System Supply Identifier | 534961 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 17","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300753","type":"LOCAL"},{"code":"534962","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300753 = Hospital System Supply Identifier | 534962 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 20","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300754","type":"LOCAL"},{"code":"534963","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300754 = Hospital System Supply Identifier | 534963 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII C D 23","code_information":[{"code":"Sx00-5110-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300755","type":"LOCAL"},{"code":"534964","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300755 = Hospital System Supply Identifier | 534964 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII E F 17","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300756","type":"LOCAL"},{"code":"534965","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300756 = Hospital System Supply Identifier | 534965 = Lawson ID"}]},{"description":"INSERT TIBIAL KNEE FIXED LIPPED MG II 00511004313 13MM SIZE E F","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"1328154","type":"LOCAL"},{"code":"1112266","type":"LOCAL"}],"standard_charges":[{"gross_charge":5158.75,"discounted_cash":3611.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 1328154 = Hospital System Supply Identifier | 1112266 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SURF 9X74MM","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"30968","type":"LOCAL"},{"code":"324073","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 30968 = Hospital System Supply Identifier | 324073 = Lawson ID"}]},{"description":"ARTICULAR TIBIAL","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"30969","type":"LOCAL"},{"code":"324074","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 30969 = Hospital System Supply Identifier | 324074 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SURF 23X74MM","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"2512","type":"LOCAL"},{"code":"340074","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 2512 = Hospital System Supply Identifier | 340074 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC MGII E F 20","code_information":[{"code":"Sx00-5110-043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300757","type":"LOCAL"},{"code":"534966","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300757 = Hospital System Supply Identifier | 534966 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G H J K 17","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300759","type":"LOCAL"},{"code":"534968","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300759 = Hospital System Supply Identifier | 534968 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G H J K 20","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300760","type":"LOCAL"},{"code":"534969","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300760 = Hospital System Supply Identifier | 534969 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G H J K 15","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300758","type":"LOCAL"},{"code":"534967","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300758 = Hospital System Supply Identifier | 534967 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC G H J K 23","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300761","type":"LOCAL"},{"code":"534970","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300761 = Hospital System Supply Identifier | 534970 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SURF 9X82MM","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"161129","type":"LOCAL"},{"code":"401982","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 161129 = Hospital System Supply Identifier | 401982 = Lawson ID"}]},{"description":"TIBIAL ARTIC SURFACE 11MM","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"76886","type":"LOCAL"},{"code":"380806","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 76886 = Hospital System Supply Identifier | 380806 = Lawson ID"}]},{"description":"IMP KNEE TIB INS NXGN BLU","code_information":[{"code":"Sx00-5110-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303476","type":"LOCAL"},{"code":"412361","type":"LOCAL"}],"standard_charges":[{"gross_charge":6828.37,"discounted_cash":4779.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303476 = Hospital System Supply Identifier | 412361 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X55MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280101","type":"LOCAL"},{"code":"522160","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280101 = Hospital System Supply Identifier | 522160 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X45MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280099","type":"LOCAL"},{"code":"522158","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280099 = Hospital System Supply Identifier | 522158 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X60MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280102","type":"LOCAL"},{"code":"522161","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280102 = Hospital System Supply Identifier | 522161 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X25MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280098","type":"LOCAL"},{"code":"522157","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280098 = Hospital System Supply Identifier | 522157 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X50MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280100","type":"LOCAL"},{"code":"522159","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280100 = Hospital System Supply Identifier | 522159 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X40MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"30975","type":"LOCAL"},{"code":"324081","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 30975 = Hospital System Supply Identifier | 324081 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X35MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"32490","type":"LOCAL"},{"code":"337166","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 32490 = Hospital System Supply Identifier | 337166 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X20MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"30974","type":"LOCAL"},{"code":"324079","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 30974 = Hospital System Supply Identifier | 324079 = Lawson ID"}]},{"description":"SCREW BONE MGII STRL 6.5X30MM","code_information":[{"code":"Sx00-5110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"27661","type":"LOCAL"},{"code":"317221","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 27661 = Hospital System Supply Identifier | 317221 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X60MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280110","type":"LOCAL"},{"code":"522169","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280110 = Hospital System Supply Identifier | 522169 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X55MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280109","type":"LOCAL"},{"code":"522168","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280109 = Hospital System Supply Identifier | 522168 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X50MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280108","type":"LOCAL"},{"code":"522167","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280108 = Hospital System Supply Identifier | 522167 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X40MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280106","type":"LOCAL"},{"code":"522165","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280106 = Hospital System Supply Identifier | 522165 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X45MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280107","type":"LOCAL"},{"code":"522166","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280107 = Hospital System Supply Identifier | 522166 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X25MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280104","type":"LOCAL"},{"code":"522163","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280104 = Hospital System Supply Identifier | 522163 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X20MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280103","type":"LOCAL"},{"code":"522162","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280103 = Hospital System Supply Identifier | 522162 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X35MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"7402","type":"LOCAL"},{"code":"360372","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 7402 = Hospital System Supply Identifier | 360372 = Lawson ID"}]},{"description":"SCREW BONE MGII NS 6.5X30MM","code_information":[{"code":"Sx00-5110-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"280105","type":"LOCAL"},{"code":"522164","type":"LOCAL"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280105 = Hospital System Supply Identifier | 522164 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ4","code_information":[{"code":"Sx00-5112-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300762","type":"LOCAL"},{"code":"534971","type":"LOCAL"}],"standard_charges":[{"gross_charge":16930.32,"discounted_cash":11851.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300762 = Hospital System Supply Identifier | 534971 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ5","code_information":[{"code":"Sx00-5112-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"30976","type":"LOCAL"},{"code":"324082","type":"LOCAL"}],"standard_charges":[{"gross_charge":16930.32,"discounted_cash":11851.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 30976 = Hospital System Supply Identifier | 324082 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ5","code_information":[{"code":"Sx00-5112-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300763","type":"LOCAL"},{"code":"534972","type":"LOCAL"}],"standard_charges":[{"gross_charge":16930.32,"discounted_cash":11851.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300763 = Hospital System Supply Identifier | 534972 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII LT SZ6","code_information":[{"code":"Sx00-5112-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"30977","type":"LOCAL"},{"code":"324083","type":"LOCAL"}],"standard_charges":[{"gross_charge":16930.32,"discounted_cash":11851.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 30977 = Hospital System Supply Identifier | 324083 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ6","code_information":[{"code":"Sx00-5112-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300764","type":"LOCAL"},{"code":"534973","type":"LOCAL"}],"standard_charges":[{"gross_charge":16930.32,"discounted_cash":11851.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300764 = Hospital System Supply Identifier | 534973 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII 6T SZ7","code_information":[{"code":"Sx00-5112-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300765","type":"LOCAL"},{"code":"534974","type":"LOCAL"}],"standard_charges":[{"gross_charge":16930.32,"discounted_cash":11851.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300765 = Hospital System Supply Identifier | 534974 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP MGII RT SZ7","code_information":[{"code":"Sx00-5112-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300766","type":"LOCAL"},{"code":"534975","type":"LOCAL"}],"standard_charges":[{"gross_charge":16930.32,"discounted_cash":11851.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300766 = Hospital System Supply Identifier | 534975 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZB","code_information":[{"code":"Sx00-5112-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300768","type":"LOCAL"},{"code":"534977","type":"LOCAL"}],"standard_charges":[{"gross_charge":12307.68,"discounted_cash":8615.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300768 = Hospital System Supply Identifier | 534977 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZA","code_information":[{"code":"Sx00-5112-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300767","type":"LOCAL"},{"code":"534976","type":"LOCAL"}],"standard_charges":[{"gross_charge":12307.68,"discounted_cash":8615.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300767 = Hospital System Supply Identifier | 534976 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZD","code_information":[{"code":"Sx00-5112-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300769","type":"LOCAL"},{"code":"534978","type":"LOCAL"}],"standard_charges":[{"gross_charge":11117.96,"discounted_cash":7782.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300769 = Hospital System Supply Identifier | 534978 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZC","code_information":[{"code":"Sx00-5112-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300770","type":"LOCAL"},{"code":"534979","type":"LOCAL"}],"standard_charges":[{"gross_charge":12307.68,"discounted_cash":8615.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300770 = Hospital System Supply Identifier | 534979 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZD","code_information":[{"code":"Sx00-5112-037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300771","type":"LOCAL"},{"code":"534980","type":"LOCAL"}],"standard_charges":[{"gross_charge":12307.68,"discounted_cash":8615.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300771 = Hospital System Supply Identifier | 534980 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZE","code_information":[{"code":"Sx00-5112-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300772","type":"LOCAL"},{"code":"534981","type":"LOCAL"}],"standard_charges":[{"gross_charge":12307.68,"discounted_cash":8615.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300772 = Hospital System Supply Identifier | 534981 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZF","code_information":[{"code":"Sx00-5112-047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300773","type":"LOCAL"},{"code":"534982","type":"LOCAL"}],"standard_charges":[{"gross_charge":12307.68,"discounted_cash":8615.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300773 = Hospital System Supply Identifier | 534982 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZK","code_information":[{"code":"Sx00-5112-055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300774","type":"LOCAL"},{"code":"534983","type":"LOCAL"}],"standard_charges":[{"gross_charge":11117.96,"discounted_cash":7782.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300774 = Hospital System Supply Identifier | 534983 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZK","code_information":[{"code":"Sx00-5112-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300778","type":"LOCAL"},{"code":"534987","type":"LOCAL"}],"standard_charges":[{"gross_charge":12307.68,"discounted_cash":8615.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300778 = Hospital System Supply Identifier | 534987 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZJ","code_information":[{"code":"Sx00-5112-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300777","type":"LOCAL"},{"code":"534986","type":"LOCAL"}],"standard_charges":[{"gross_charge":12307.68,"discounted_cash":8615.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300777 = Hospital System Supply Identifier | 534986 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZG","code_information":[{"code":"Sx00-5112-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300775","type":"LOCAL"},{"code":"534984","type":"LOCAL"}],"standard_charges":[{"gross_charge":12307.68,"discounted_cash":8615.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300775 = Hospital System Supply Identifier | 534984 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT MGII SZH","code_information":[{"code":"Sx00-5112-057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300776","type":"LOCAL"},{"code":"534985","type":"LOCAL"}],"standard_charges":[{"gross_charge":12307.68,"discounted_cash":8615.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300776 = Hospital System Supply Identifier | 534985 = Lawson ID"}]},{"description":"BIT DRILL PTELA/FEM","code_information":[{"code":"Sx00-5120-052","type":"CDM"},{"code":"272","type":"RC"},{"code":"27258","type":"LOCAL"},{"code":"313633","type":"LOCAL"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 27258 = Hospital System Supply Identifier | 313633 = Lawson ID"}]},{"description":"BIT DRILL 12.7MM NSTRL PEG SS TIBIA MG II","code_information":[{"code":"Sx00-5120-067","type":"CDM"},{"code":"272","type":"RC"},{"code":"971403","type":"LOCAL"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":367.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 971403 = Hospital System Supply Identifier"}]},{"description":"BIT DRILL W/CONNECT 3.2MM","code_information":[{"code":"Sx00-5120-085","type":"CDM"},{"code":"272","type":"RC"},{"code":"12398","type":"LOCAL"},{"code":"237602","type":"LOCAL"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 12398 = Hospital System Supply Identifier | 237602 = Lawson ID"}]},{"description":"SCRDRVR HEX MGII 3.5MM","code_information":[{"code":"Sx00-5120-087","type":"CDM"},{"code":"272","type":"RC"},{"code":"306118","type":"LOCAL"},{"code":"452439","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 306118 = Hospital System Supply Identifier | 452439 = Lawson ID"}]},{"description":"PLATE TIBIAL 0D NSTRL BOOM SS KNEE MG II","code_information":[{"code":"Sx00-5125-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"957012","type":"LOCAL"}],"standard_charges":[{"gross_charge":1882.65,"discounted_cash":1317.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 957012 = Hospital System Supply Identifier"}]},{"description":"CLMP INDEPEND LOK 2D LG XTRFX","code_information":[{"code":"Sx00-5200-090","type":"CDM"},{"code":"272","type":"RC"},{"code":"384966","type":"LOCAL"},{"code":"623375","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384966 = Hospital System Supply Identifier | 623375 = Lawson ID"}]},{"description":"IMP ORTH BAR XTRAFIX 11X100MM","code_information":[{"code":"Sx00-5202-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"384706","type":"LOCAL"},{"code":"421381","type":"LOCAL"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384706 = Hospital System Supply Identifier | 421381 = Lawson ID"}]},{"description":"POST FIX EXT STR 11MM","code_information":[{"code":"Sx00-5202-090","type":"CDM"},{"code":"272","type":"RC"},{"code":"383586","type":"LOCAL"},{"code":"395473","type":"LOCAL"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383586 = Hospital System Supply Identifier | 395473 = Lawson ID"}]},{"description":"POST FIX EXT STR 11MM 30DEGREE","code_information":[{"code":"Sx00-5202-090","type":"CDM"},{"code":"272","type":"RC"},{"code":"384938","type":"LOCAL"},{"code":"595879","type":"LOCAL"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384938 = Hospital System Supply Identifier | 595879 = Lawson ID"}]},{"description":"BAR CARBON XTRAFX 11X500MM","code_information":[{"code":"Sx00-5203-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"384965","type":"LOCAL"},{"code":"623374","type":"LOCAL"}],"standard_charges":[{"gross_charge":1102.95,"discounted_cash":772.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384965 = Hospital System Supply Identifier | 623374 = Lawson ID"}]},{"description":"BAR CARBON XTRAFIX 11X350MM","code_information":[{"code":"Sx00-5203-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"384733","type":"LOCAL"},{"code":"425147","type":"LOCAL"}],"standard_charges":[{"gross_charge":963.24,"discounted_cash":674.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384733 = Hospital System Supply Identifier | 425147 = Lawson ID"}]},{"description":"BAR CARBON XTRAFIX 11X150MM","code_information":[{"code":"Sx00-5203-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"384731","type":"LOCAL"},{"code":"425145","type":"LOCAL"}],"standard_charges":[{"gross_charge":860.7,"discounted_cash":602.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384731 = Hospital System Supply Identifier | 425145 = Lawson ID"}]},{"description":"BAR CARBON XTRAFIX 11X200MM","code_information":[{"code":"Sx00-5203-011","type":"CDM"},{"code":"272","type":"RC"},{"code":"384732","type":"LOCAL"},{"code":"425146","type":"LOCAL"}],"standard_charges":[{"gross_charge":926.25,"discounted_cash":648.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384732 = Hospital System Supply Identifier | 425146 = Lawson ID"}]},{"description":"IMP FIX PIN HALF 4X100X35MM","code_information":[{"code":"Sx00-5204-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"384708","type":"LOCAL"},{"code":"421384","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384708 = Hospital System Supply Identifier | 421384 = Lawson ID"}]},{"description":"PIN FIX EXT HALF 5X160X35MM","code_information":[{"code":"Sx00-5204-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"383587","type":"LOCAL"},{"code":"395474","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383587 = Hospital System Supply Identifier | 395474 = Lawson ID"}]},{"description":"PIN FIX EXT 5X160X55MM","code_information":[{"code":"Sx00-5204-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"383588","type":"LOCAL"},{"code":"395475","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383588 = Hospital System Supply Identifier | 395475 = Lawson ID"}]},{"description":"PIN FIX EXT HALF 5X200X45MM","code_information":[{"code":"Sx00-5204-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"384744","type":"LOCAL"},{"code":"428125","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384744 = Hospital System Supply Identifier | 428125 = Lawson ID"}]},{"description":"PIN FIX EXT HALF 5X200X65MM","code_information":[{"code":"Sx00-5204-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"384797","type":"LOCAL"},{"code":"438994","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384797 = Hospital System Supply Identifier | 438994 = Lawson ID"}]},{"description":"PIN FIX EXT 6X200X55MM","code_information":[{"code":"Sx00-5204-060","type":"CDM"},{"code":"272","type":"RC"},{"code":"336577","type":"LOCAL"},{"code":"395476","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 336577 = Hospital System Supply Identifier | 395476 = Lawson ID"}]},{"description":"PIN FIX EXT TRNSFIXNG BLK 6MM","code_information":[{"code":"Sx00-5204-090","type":"CDM"},{"code":"272","type":"RC"},{"code":"383589","type":"LOCAL"},{"code":"395477","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383589 = Hospital System Supply Identifier | 395477 = Lawson ID"}]},{"description":"PIN 1/2 BLUNT 5X160X55MM","code_information":[{"code":"Sx00-5205-050","type":"CDM"},{"code":"272","type":"RC"},{"code":"384734","type":"LOCAL"},{"code":"425148","type":"LOCAL"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384734 = Hospital System Supply Identifier | 425148 = Lawson ID"}]},{"description":"BIT DRILL LNG 4.0MM","code_information":[{"code":"Sx00-5207-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"384890","type":"LOCAL"},{"code":"463697","type":"LOCAL"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":413.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 384890 = Hospital System Supply Identifier | 463697 = Lawson ID"}]},{"description":"DRILL MED 4.0MM","code_information":[{"code":"Sx00-5207-040","type":"CDM"},{"code":"272","type":"RC"},{"code":"383590","type":"LOCAL"},{"code":"395478","type":"LOCAL"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":413.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383590 = Hospital System Supply Identifier | 395478 = Lawson ID"}]},{"description":"DRILL 4.5MM","code_information":[{"code":"Sx00-5207-045","type":"CDM"},{"code":"272","type":"RC"},{"code":"383591","type":"LOCAL"},{"code":"395479","type":"LOCAL"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":413.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 383591 = Hospital System Supply Identifier | 395479 = Lawson ID"}]},{"description":"IMP KNEE FEM POR I/B 54X55","code_information":[{"code":"Sx00-5220-006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300779","type":"LOCAL"},{"code":"534988","type":"LOCAL"}],"standard_charges":[{"gross_charge":16279.82,"discounted_cash":11395.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300779 = Hospital System Supply Identifier | 534988 = Lawson ID"}]},{"description":"IMP KNEE FEM POR I/B 59X60","code_information":[{"code":"Sx00-5220-007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300780","type":"LOCAL"},{"code":"534989","type":"LOCAL"}],"standard_charges":[{"gross_charge":16279.82,"discounted_cash":11395.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300780 = Hospital System Supply Identifier | 534989 = Lawson ID"}]},{"description":"IMP KNEE PTELA COMP 32MM 7MM","code_information":[{"code":"Sx00-5220-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303679","type":"LOCAL"},{"code":"418240","type":"LOCAL"}],"standard_charges":[{"gross_charge":5806.35,"discounted_cash":4064.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303679 = Hospital System Supply Identifier | 418240 = Lawson ID"}]},{"description":"IMP KNEE PTELA DOME 3-PEG 35","code_information":[{"code":"Sx00-5220-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300786","type":"LOCAL"},{"code":"534995","type":"LOCAL"}],"standard_charges":[{"gross_charge":5806.35,"discounted_cash":4064.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300786 = Hospital System Supply Identifier | 534995 = Lawson ID"}]},{"description":"IMP KNEE PTELA DOME 3-PEG 38","code_information":[{"code":"Sx00-5220-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300787","type":"LOCAL"},{"code":"534996","type":"LOCAL"}],"standard_charges":[{"gross_charge":5806.35,"discounted_cash":4064.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300787 = Hospital System Supply Identifier | 534996 = Lawson ID"}]},{"description":"IMP KNEE PTELA DOME 3-PEG 41","code_information":[{"code":"Sx00-5220-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300788","type":"LOCAL"},{"code":"534997","type":"LOCAL"}],"standard_charges":[{"gross_charge":5806.35,"discounted_cash":4064.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300788 = Hospital System Supply Identifier | 534997 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ54 44X59","code_information":[{"code":"Sx00-5220-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300789","type":"LOCAL"},{"code":"534998","type":"LOCAL"}],"standard_charges":[{"gross_charge":11193.93,"discounted_cash":7835.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300789 = Hospital System Supply Identifier | 534998 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ69 56X75","code_information":[{"code":"Sx00-5220-024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300790","type":"LOCAL"},{"code":"534999","type":"LOCAL"}],"standard_charges":[{"gross_charge":11193.93,"discounted_cash":7835.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300790 = Hospital System Supply Identifier | 534999 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ74 60X81","code_information":[{"code":"Sx00-5220-025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300791","type":"LOCAL"},{"code":"535000","type":"LOCAL"}],"standard_charges":[{"gross_charge":11193.93,"discounted_cash":7835.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300791 = Hospital System Supply Identifier | 535000 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ54 48X64","code_information":[{"code":"Sx00-5220-026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300792","type":"LOCAL"},{"code":"535001","type":"LOCAL"}],"standard_charges":[{"gross_charge":11193.93,"discounted_cash":7835.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300792 = Hospital System Supply Identifier | 535001 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ59 52X70","code_information":[{"code":"Sx00-5220-027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300793","type":"LOCAL"},{"code":"535002","type":"LOCAL"}],"standard_charges":[{"gross_charge":11193.93,"discounted_cash":7835.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300793 = Hospital System Supply Identifier | 535002 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ64 56X75","code_information":[{"code":"Sx00-5220-028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300794","type":"LOCAL"},{"code":"535003","type":"LOCAL"}],"standard_charges":[{"gross_charge":11193.93,"discounted_cash":7835.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300794 = Hospital System Supply Identifier | 535003 = Lawson ID"}]},{"description":"IMP KNEE TIB BSPLT SZ69 60X81","code_information":[{"code":"Sx00-5220-029","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300795","type":"LOCAL"},{"code":"535004","type":"LOCAL"}],"standard_charges":[{"gross_charge":11193.93,"discounted_cash":7835.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300795 = Hospital System Supply Identifier | 535004 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 54X8","code_information":[{"code":"Sx00-5220-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300801","type":"LOCAL"},{"code":"535010","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300801 = Hospital System Supply Identifier | 535010 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 54X10","code_information":[{"code":"Sx00-5220-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300802","type":"LOCAL"},{"code":"535011","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300802 = Hospital System Supply Identifier | 535011 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 54X12","code_information":[{"code":"Sx00-5220-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300803","type":"LOCAL"},{"code":"535012","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300803 = Hospital System Supply Identifier | 535012 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 54X15","code_information":[{"code":"Sx00-5220-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300804","type":"LOCAL"},{"code":"535013","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300804 = Hospital System Supply Identifier | 535013 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 59X8","code_information":[{"code":"Sx00-5220-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300810","type":"LOCAL"},{"code":"535019","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300810 = Hospital System Supply Identifier | 535019 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 59X10","code_information":[{"code":"Sx00-5220-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300811","type":"LOCAL"},{"code":"535020","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300811 = Hospital System Supply Identifier | 535020 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 59X12","code_information":[{"code":"Sx00-5220-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300812","type":"LOCAL"},{"code":"535021","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300812 = Hospital System Supply Identifier | 535021 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 59X15","code_information":[{"code":"Sx00-5220-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300813","type":"LOCAL"},{"code":"535022","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300813 = Hospital System Supply Identifier | 535022 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 64X12","code_information":[{"code":"Sx00-5220-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300818","type":"LOCAL"},{"code":"535027","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300818 = Hospital System Supply Identifier | 535027 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 64X10","code_information":[{"code":"Sx00-5220-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300817","type":"LOCAL"},{"code":"535026","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300817 = Hospital System Supply Identifier | 535026 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 64X15","code_information":[{"code":"Sx00-5220-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300819","type":"LOCAL"},{"code":"535028","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300819 = Hospital System Supply Identifier | 535028 = Lawson ID"}]},{"description":"IMP KNEE TIB 18X64MM","code_information":[{"code":"Sx00-5220-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303480","type":"LOCAL"},{"code":"412365","type":"LOCAL"}],"standard_charges":[{"gross_charge":9186.59,"discounted_cash":6430.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303480 = Hospital System Supply Identifier | 412365 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 64X8","code_information":[{"code":"Sx00-5220-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300816","type":"LOCAL"},{"code":"535025","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300816 = Hospital System Supply Identifier | 535025 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 69X15","code_information":[{"code":"Sx00-5220-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300829","type":"LOCAL"},{"code":"535038","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300829 = Hospital System Supply Identifier | 535038 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 69X10","code_information":[{"code":"Sx00-5220-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300827","type":"LOCAL"},{"code":"535036","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300827 = Hospital System Supply Identifier | 535036 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 69X12","code_information":[{"code":"Sx00-5220-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300828","type":"LOCAL"},{"code":"535037","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300828 = Hospital System Supply Identifier | 535037 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 74X10","code_information":[{"code":"Sx00-5220-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300837","type":"LOCAL"},{"code":"535046","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300837 = Hospital System Supply Identifier | 535046 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 74X12","code_information":[{"code":"Sx00-5220-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300838","type":"LOCAL"},{"code":"535047","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300838 = Hospital System Supply Identifier | 535047 = Lawson ID"}]},{"description":"IMP KNEE TIB PLY I/B 74X15","code_information":[{"code":"Sx00-5220-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300839","type":"LOCAL"},{"code":"535048","type":"LOCAL"}],"standard_charges":[{"gross_charge":8958.77,"discounted_cash":6271.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300839 = Hospital System Supply Identifier | 535048 = Lawson ID"}]},{"description":"IMP KNEE PTELA DOME 3-PEG 32","code_information":[{"code":"Sx00-5220-051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300840","type":"LOCAL"},{"code":"535049","type":"LOCAL"}],"standard_charges":[{"gross_charge":5806.35,"discounted_cash":4064.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300840 = Hospital System Supply Identifier | 535049 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 59/54X15","code_information":[{"code":"Sx00-5220-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300844","type":"LOCAL"},{"code":"535053","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":3460.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300844 = Hospital System Supply Identifier | 535053 = Lawson ID"}]},{"description":"IMP KNEE PTELA DOME 3-PEG 35","code_information":[{"code":"Sx00-5220-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300841","type":"LOCAL"},{"code":"535050","type":"LOCAL"}],"standard_charges":[{"gross_charge":5806.35,"discounted_cash":4064.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300841 = Hospital System Supply Identifier | 535050 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 59/54X10","code_information":[{"code":"Sx00-5220-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300842","type":"LOCAL"},{"code":"535051","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":3460.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300842 = Hospital System Supply Identifier | 535051 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 59/54X12","code_information":[{"code":"Sx00-5220-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300843","type":"LOCAL"},{"code":"535052","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":3460.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300843 = Hospital System Supply Identifier | 535052 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 64/59X15","code_information":[{"code":"Sx00-5220-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300848","type":"LOCAL"},{"code":"535057","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":3460.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300848 = Hospital System Supply Identifier | 535057 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 64/59X12","code_information":[{"code":"Sx00-5220-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300847","type":"LOCAL"},{"code":"535056","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":3460.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300847 = Hospital System Supply Identifier | 535056 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 64/59X10","code_information":[{"code":"Sx00-5220-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300846","type":"LOCAL"},{"code":"535055","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":3460.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300846 = Hospital System Supply Identifier | 535055 = Lawson ID"}]},{"description":"IMP KNEE PTELA DOM 3-PEG 38","code_information":[{"code":"Sx00-5220-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300845","type":"LOCAL"},{"code":"535054","type":"LOCAL"}],"standard_charges":[{"gross_charge":5806.35,"discounted_cash":4064.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300845 = Hospital System Supply Identifier | 535054 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 69/64X15","code_information":[{"code":"Sx00-5220-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300851","type":"LOCAL"},{"code":"535060","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":3460.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300851 = Hospital System Supply Identifier | 535060 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 69/64X10","code_information":[{"code":"Sx00-5220-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300849","type":"LOCAL"},{"code":"535058","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":3460.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300849 = Hospital System Supply Identifier | 535058 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC 69/64X12","code_information":[{"code":"Sx00-5220-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300850","type":"LOCAL"},{"code":"535059","type":"LOCAL"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":3460.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300850 = Hospital System Supply Identifier | 535059 = Lawson ID"}]},{"description":"IMP TIB WDG HLF SZ74 16D 11.5","code_information":[{"code":"Sx00-5220-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300875","type":"LOCAL"},{"code":"535084","type":"LOCAL"}],"standard_charges":[{"gross_charge":8567.21,"discounted_cash":5997.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300875 = Hospital System Supply Identifier | 535084 = Lawson ID"}]},{"description":"IMP KNEE TIB CUP LOK","code_information":[{"code":"Sx00-5220-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303508","type":"LOCAL"},{"code":"412507","type":"LOCAL"}],"standard_charges":[{"gross_charge":1421.36,"discounted_cash":994.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303508 = Hospital System Supply Identifier | 412507 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 15X25","code_information":[{"code":"Sx00-5220-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300877","type":"LOCAL"},{"code":"535086","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300877 = Hospital System Supply Identifier | 535086 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 15X40","code_information":[{"code":"Sx00-5220-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300878","type":"LOCAL"},{"code":"535087","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300878 = Hospital System Supply Identifier | 535087 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 10X75","code_information":[{"code":"Sx00-5220-069","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300879","type":"LOCAL"},{"code":"535088","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300879 = Hospital System Supply Identifier | 535088 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 12X75","code_information":[{"code":"Sx00-5220-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300880","type":"LOCAL"},{"code":"535089","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300880 = Hospital System Supply Identifier | 535089 = Lawson ID"}]},{"description":"IMP STEM FLUTI/B II 13X75MM EX","code_information":[{"code":"Sx00-5220-071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306119","type":"LOCAL"},{"code":"452445","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 306119 = Hospital System Supply Identifier | 452445 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 14X75","code_information":[{"code":"Sx00-5220-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300881","type":"LOCAL"},{"code":"535090","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300881 = Hospital System Supply Identifier | 535090 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 15X75","code_information":[{"code":"Sx00-5220-073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300882","type":"LOCAL"},{"code":"535091","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300882 = Hospital System Supply Identifier | 535091 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 16X75","code_information":[{"code":"Sx00-5220-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300883","type":"LOCAL"},{"code":"535092","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300883 = Hospital System Supply Identifier | 535092 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 17X75","code_information":[{"code":"Sx00-5220-075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300884","type":"LOCAL"},{"code":"535093","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300884 = Hospital System Supply Identifier | 535093 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 18X75","code_information":[{"code":"Sx00-5220-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300885","type":"LOCAL"},{"code":"535094","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300885 = Hospital System Supply Identifier | 535094 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 19X75","code_information":[{"code":"Sx00-5220-077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300886","type":"LOCAL"},{"code":"535095","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300886 = Hospital System Supply Identifier | 535095 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 20X75","code_information":[{"code":"Sx00-5220-078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300887","type":"LOCAL"},{"code":"535096","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300887 = Hospital System Supply Identifier | 535096 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 22X75","code_information":[{"code":"Sx00-5220-079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300888","type":"LOCAL"},{"code":"535097","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300888 = Hospital System Supply Identifier | 535097 = Lawson ID"}]},{"description":"IMP KNEE ROD FLUT I/B 24X75","code_information":[{"code":"Sx00-5220-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300889","type":"LOCAL"},{"code":"535098","type":"LOCAL"}],"standard_charges":[{"gross_charge":2275.0,"discounted_cash":1592.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300889 = Hospital System Supply Identifier | 535098 = Lawson ID"}]},{"description":"SCREW KNEE TIB WDG ATTCH I/B","code_information":[{"code":"Sx00-5220-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"300890","type":"LOCAL"},{"code":"535099","type":"LOCAL"}],"standard_charges":[{"gross_charge":913.0,"discounted_cash":639.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300890 = Hospital System Supply Identifier | 535099 = Lawson ID"}]},{"description":"PIN HEADLSS TIB WDG PRVSNL 48","code_information":[{"code":"Sx00-5222-039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"24171","type":"LOCAL"},{"code":"258701","type":"LOCAL"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 24171 = Hospital System Supply Identifier | 258701 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ54 21","code_information":[{"code":"Sx00-5224-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300894","type":"LOCAL"},{"code":"535103","type":"LOCAL"}],"standard_charges":[{"gross_charge":11174.59,"discounted_cash":7822.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300894 = Hospital System Supply Identifier | 535103 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ54 18","code_information":[{"code":"Sx00-5224-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300893","type":"LOCAL"},{"code":"535102","type":"LOCAL"}],"standard_charges":[{"gross_charge":11174.59,"discounted_cash":7822.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300893 = Hospital System Supply Identifier | 535102 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ54 25","code_information":[{"code":"Sx00-5224-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300895","type":"LOCAL"},{"code":"535104","type":"LOCAL"}],"standard_charges":[{"gross_charge":11174.59,"discounted_cash":7822.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300895 = Hospital System Supply Identifier | 535104 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ54 12","code_information":[{"code":"Sx00-5224-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300891","type":"LOCAL"},{"code":"535100","type":"LOCAL"}],"standard_charges":[{"gross_charge":11174.59,"discounted_cash":7822.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300891 = Hospital System Supply Identifier | 535100 = Lawson ID"}]},{"description":"IMP KNEE TIB 10X54MM","code_information":[{"code":"Sx00-5224-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303483","type":"LOCAL"},{"code":"412368","type":"LOCAL"}],"standard_charges":[{"gross_charge":11174.59,"discounted_cash":7822.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303483 = Hospital System Supply Identifier | 412368 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ54 15","code_information":[{"code":"Sx00-5224-031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300892","type":"LOCAL"},{"code":"535101","type":"LOCAL"}],"standard_charges":[{"gross_charge":11174.59,"discounted_cash":7822.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300892 = Hospital System Supply Identifier | 535101 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ59 25","code_information":[{"code":"Sx00-5224-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300900","type":"LOCAL"},{"code":"535109","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300900 = Hospital System Supply Identifier | 535109 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ59 21","code_information":[{"code":"Sx00-5224-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300899","type":"LOCAL"},{"code":"535108","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300899 = Hospital System Supply Identifier | 535108 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ59 15","code_information":[{"code":"Sx00-5224-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300898","type":"LOCAL"},{"code":"535107","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300898 = Hospital System Supply Identifier | 535107 = Lawson ID"}]},{"description":"IMP KNEE ARTC SURF I/B CCK 18","code_information":[{"code":"Sx00-5224-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304835","type":"LOCAL"},{"code":"452370","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304835 = Hospital System Supply Identifier | 452370 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ59 10","code_information":[{"code":"Sx00-5224-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300896","type":"LOCAL"},{"code":"535105","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300896 = Hospital System Supply Identifier | 535105 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ59 12","code_information":[{"code":"Sx00-5224-032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300897","type":"LOCAL"},{"code":"535106","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300897 = Hospital System Supply Identifier | 535106 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ64 10","code_information":[{"code":"Sx00-5224-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300901","type":"LOCAL"},{"code":"535110","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300901 = Hospital System Supply Identifier | 535110 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ64 12","code_information":[{"code":"Sx00-5224-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300902","type":"LOCAL"},{"code":"535111","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300902 = Hospital System Supply Identifier | 535111 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ64 15","code_information":[{"code":"Sx00-5224-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300903","type":"LOCAL"},{"code":"535112","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300903 = Hospital System Supply Identifier | 535112 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ64 18","code_information":[{"code":"Sx00-5224-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300904","type":"LOCAL"},{"code":"535113","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300904 = Hospital System Supply Identifier | 535113 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ64 21","code_information":[{"code":"Sx00-5224-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300905","type":"LOCAL"},{"code":"535114","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300905 = Hospital System Supply Identifier | 535114 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ64 25","code_information":[{"code":"Sx00-5224-033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300906","type":"LOCAL"},{"code":"535115","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300906 = Hospital System Supply Identifier | 535115 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ69 10","code_information":[{"code":"Sx00-5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300907","type":"LOCAL"},{"code":"535116","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300907 = Hospital System Supply Identifier | 535116 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ69 12","code_information":[{"code":"Sx00-5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300908","type":"LOCAL"},{"code":"535117","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300908 = Hospital System Supply Identifier | 535117 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ69 15","code_information":[{"code":"Sx00-5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300909","type":"LOCAL"},{"code":"535118","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300909 = Hospital System Supply Identifier | 535118 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ69 21","code_information":[{"code":"Sx00-5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300910","type":"LOCAL"},{"code":"535119","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300910 = Hospital System Supply Identifier | 535119 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ69 25","code_information":[{"code":"Sx00-5224-034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300911","type":"LOCAL"},{"code":"535120","type":"LOCAL"}],"standard_charges":[{"gross_charge":10951.87,"discounted_cash":7666.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300911 = Hospital System Supply Identifier | 535120 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ74 25","code_information":[{"code":"Sx00-5224-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300917","type":"LOCAL"},{"code":"535126","type":"LOCAL"}],"standard_charges":[{"gross_charge":11174.59,"discounted_cash":7822.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300917 = Hospital System Supply Identifier | 535126 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ74 18","code_information":[{"code":"Sx00-5224-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300915","type":"LOCAL"},{"code":"535124","type":"LOCAL"}],"standard_charges":[{"gross_charge":11174.59,"discounted_cash":7822.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300915 = Hospital System Supply Identifier | 535124 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ74 21","code_information":[{"code":"Sx00-5224-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300916","type":"LOCAL"},{"code":"535125","type":"LOCAL"}],"standard_charges":[{"gross_charge":11174.59,"discounted_cash":7822.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300916 = Hospital System Supply Identifier | 535125 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ74 12","code_information":[{"code":"Sx00-5224-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300913","type":"LOCAL"},{"code":"535122","type":"LOCAL"}],"standard_charges":[{"gross_charge":11174.59,"discounted_cash":7822.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300913 = Hospital System Supply Identifier | 535122 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ74 10","code_information":[{"code":"Sx00-5224-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300912","type":"LOCAL"},{"code":"535121","type":"LOCAL"}],"standard_charges":[{"gross_charge":11174.59,"discounted_cash":7822.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300912 = Hospital System Supply Identifier | 535121 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC I/B SZ74 15","code_information":[{"code":"Sx00-5224-035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300914","type":"LOCAL"},{"code":"535123","type":"LOCAL"}],"standard_charges":[{"gross_charge":11174.59,"discounted_cash":7822.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300914 = Hospital System Supply Identifier | 535123 = Lawson ID"}]},{"description":"IMP KNEE FEM STD 5X5X54MM","code_information":[{"code":"Sx00-5224-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303509","type":"LOCAL"},{"code":"412508","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 303509 = Hospital System Supply Identifier | 412508 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 54X5X5","code_information":[{"code":"Sx00-5224-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300918","type":"LOCAL"},{"code":"535127","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300918 = Hospital System Supply Identifier | 535127 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 54X10","code_information":[{"code":"Sx00-5224-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300919","type":"LOCAL"},{"code":"535128","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300919 = Hospital System Supply Identifier | 535128 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 54X10X5","code_information":[{"code":"Sx00-5224-061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300920","type":"LOCAL"},{"code":"535129","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300920 = Hospital System Supply Identifier | 535129 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 59X10X5","code_information":[{"code":"Sx00-5224-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300924","type":"LOCAL"},{"code":"535133","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300924 = Hospital System Supply Identifier | 535133 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 59X10","code_information":[{"code":"Sx00-5224-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300923","type":"LOCAL"},{"code":"535132","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300923 = Hospital System Supply Identifier | 535132 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 59X5","code_information":[{"code":"Sx00-5224-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300921","type":"LOCAL"},{"code":"535130","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300921 = Hospital System Supply Identifier | 535130 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 59X5X5","code_information":[{"code":"Sx00-5224-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300922","type":"LOCAL"},{"code":"535131","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300922 = Hospital System Supply Identifier | 535131 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 64X5","code_information":[{"code":"Sx00-5224-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300925","type":"LOCAL"},{"code":"535134","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300925 = Hospital System Supply Identifier | 535134 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 64X5X5","code_information":[{"code":"Sx00-5224-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300926","type":"LOCAL"},{"code":"535135","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300926 = Hospital System Supply Identifier | 535135 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 64X10","code_information":[{"code":"Sx00-5224-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300927","type":"LOCAL"},{"code":"535136","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300927 = Hospital System Supply Identifier | 535136 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 64X10X5","code_information":[{"code":"Sx00-5224-063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300928","type":"LOCAL"},{"code":"535137","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300928 = Hospital System Supply Identifier | 535137 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 69X10","code_information":[{"code":"Sx00-5224-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300931","type":"LOCAL"},{"code":"535140","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300931 = Hospital System Supply Identifier | 535140 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 69X5","code_information":[{"code":"Sx00-5224-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300929","type":"LOCAL"},{"code":"535138","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300929 = Hospital System Supply Identifier | 535138 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 69X5X5","code_information":[{"code":"Sx00-5224-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300930","type":"LOCAL"},{"code":"535139","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300930 = Hospital System Supply Identifier | 535139 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 69X10X5","code_information":[{"code":"Sx00-5224-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300932","type":"LOCAL"},{"code":"535141","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300932 = Hospital System Supply Identifier | 535141 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 74X10X5","code_information":[{"code":"Sx00-5224-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300936","type":"LOCAL"},{"code":"535145","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300936 = Hospital System Supply Identifier | 535145 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 74X10","code_information":[{"code":"Sx00-5224-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300935","type":"LOCAL"},{"code":"535144","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300935 = Hospital System Supply Identifier | 535144 = Lawson ID"}]},{"description":"IMP KNEE FEM AUG DST 74X5","code_information":[{"code":"Sx00-5224-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300933","type":"LOCAL"},{"code":"535142","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300933 = Hospital System Supply Identifier | 535142 = Lawson ID"}]},{"description":"IMP KNEE AUG DST/POST 74X5X5","code_information":[{"code":"Sx00-5224-065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300934","type":"LOCAL"},{"code":"535143","type":"LOCAL"}],"standard_charges":[{"gross_charge":7266.87,"discounted_cash":5086.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300934 = Hospital System Supply Identifier | 535143 = Lawson ID"}]},{"description":"SCREW AUG BLCK DST I/B 5","code_information":[{"code":"Sx00-5224-090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"300937","type":"LOCAL"},{"code":"535146","type":"LOCAL"}],"standard_charges":[{"gross_charge":786.5,"discounted_cash":550.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300937 = Hospital System Supply Identifier | 535146 = Lawson ID"}]},{"description":"SCREW AUG BLCK DST I/B 10","code_information":[{"code":"Sx00-5224-091","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"300938","type":"LOCAL"},{"code":"535147","type":"LOCAL"}],"standard_charges":[{"gross_charge":786.5,"discounted_cash":550.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 300938 = Hospital System Supply Identifier | 535147 = Lawson ID"}]},{"description":"IMP FEM COMP GSM FLX SZ1 RT","code_information":[{"code":"Sx00-5410-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"132659","type":"LOCAL"},{"code":"388017","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 132659 = Hospital System Supply Identifier | 388017 = Lawson ID"}]},{"description":"IMP KNEE GSM NP FLEX FEM SIZE","code_information":[{"code":"Sx00-5410-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164563","type":"LOCAL"},{"code":"446467","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164563 = Hospital System Supply Identifier | 446467 = Lawson ID"}]},{"description":"COMPONENT FEMORAL SZ 2 RT","code_information":[{"code":"Sx00-5410-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"65593","type":"LOCAL"},{"code":"366329","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65593 = Hospital System Supply Identifier | 366329 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM NP FLX SZ2 LT","code_information":[{"code":"Sx00-5410-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162920","type":"LOCAL"},{"code":"441601","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162920 = Hospital System Supply Identifier | 441601 = Lawson ID"}]},{"description":"COMPONENT FEMORAL SZ 3 RT","code_information":[{"code":"Sx00-5410-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"65591","type":"LOCAL"},{"code":"366326","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65591 = Hospital System Supply Identifier | 366326 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM NP FLX SZ3 LT","code_information":[{"code":"Sx00-5410-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162921","type":"LOCAL"},{"code":"441602","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162921 = Hospital System Supply Identifier | 441602 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM NP FLX SZ4 RT","code_information":[{"code":"Sx00-5410-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162923","type":"LOCAL"},{"code":"441604","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162923 = Hospital System Supply Identifier | 441604 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM NP FLX SZ4 LT","code_information":[{"code":"Sx00-5410-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162922","type":"LOCAL"},{"code":"441603","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162922 = Hospital System Supply Identifier | 441603 = Lawson ID"}]},{"description":"FEMUR GSM FLEX SZ 5 RT","code_information":[{"code":"Sx00-5410-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"185019","type":"LOCAL"},{"code":"386217","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 185019 = Hospital System Supply Identifier | 386217 = Lawson ID"}]},{"description":"IMP KNEE GSM NP FLEX FEM SIZE","code_information":[{"code":"Sx00-5410-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164564","type":"LOCAL"},{"code":"446468","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164564 = Hospital System Supply Identifier | 446468 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 1-LT","code_information":[{"code":"Sx00-5412-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280125","type":"LOCAL"},{"code":"522195","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280125 = Hospital System Supply Identifier | 522195 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 1-RT","code_information":[{"code":"Sx00-5412-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280126","type":"LOCAL"},{"code":"522196","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280126 = Hospital System Supply Identifier | 522196 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 2-LT","code_information":[{"code":"Sx00-5412-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280127","type":"LOCAL"},{"code":"522197","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280127 = Hospital System Supply Identifier | 522197 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 2-RT","code_information":[{"code":"Sx00-5412-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280128","type":"LOCAL"},{"code":"522198","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280128 = Hospital System Supply Identifier | 522198 = Lawson ID"}]},{"description":"IMP KNEE GSM POR FLEX FEM SIZE","code_information":[{"code":"Sx00-5412-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164565","type":"LOCAL"},{"code":"446469","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164565 = Hospital System Supply Identifier | 446469 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 3-RT","code_information":[{"code":"Sx00-5412-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280129","type":"LOCAL"},{"code":"522199","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280129 = Hospital System Supply Identifier | 522199 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 4-RT","code_information":[{"code":"Sx00-5412-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280130","type":"LOCAL"},{"code":"522200","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280130 = Hospital System Supply Identifier | 522200 = Lawson ID"}]},{"description":"IMP KNEE GSM POR FLEX FEM SIZE","code_information":[{"code":"Sx00-5412-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164566","type":"LOCAL"},{"code":"446470","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164566 = Hospital System Supply Identifier | 446470 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 5-LT","code_information":[{"code":"Sx00-5412-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280131","type":"LOCAL"},{"code":"522201","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280131 = Hospital System Supply Identifier | 522201 = Lawson ID"}]},{"description":"IMP KNEE FEM GSM POR FLX 5-RT","code_information":[{"code":"Sx00-5412-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280132","type":"LOCAL"},{"code":"522202","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280132 = Hospital System Supply Identifier | 522202 = Lawson ID"}]},{"description":"FEMUR GFS FLEX SZ 0 LT","code_information":[{"code":"Sx00-5414-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"185015","type":"LOCAL"},{"code":"370023","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 185015 = Hospital System Supply Identifier | 370023 = Lawson ID"}]},{"description":"IMP KNEE FEM 0 RT","code_information":[{"code":"Sx00-5414-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304927","type":"LOCAL"},{"code":"453455","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304927 = Hospital System Supply Identifier | 453455 = Lawson ID"}]},{"description":"FEMORAL COMP GSF FLEX SZ 1 LT","code_information":[{"code":"Sx00-5414-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"185013","type":"LOCAL"},{"code":"369325","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 185013 = Hospital System Supply Identifier | 369325 = Lawson ID"}]},{"description":"FEMORAL COMP GSF FLEX SZ 1 RT","code_information":[{"code":"Sx00-5414-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"131100","type":"LOCAL"},{"code":"370011","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 131100 = Hospital System Supply Identifier | 370011 = Lawson ID"}]},{"description":"FEMUR GFS SZ 2 RT","code_information":[{"code":"Sx00-5414-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"131342","type":"LOCAL"},{"code":"374466","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 131342 = Hospital System Supply Identifier | 374466 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF NP FLX SZ2 LT","code_information":[{"code":"Sx00-5414-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162924","type":"LOCAL"},{"code":"441605","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162924 = Hospital System Supply Identifier | 441605 = Lawson ID"}]},{"description":"IMP GSF NP FLEX FEM SIZE 3 LEF","code_information":[{"code":"Sx00-5414-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164569","type":"LOCAL"},{"code":"446473","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164569 = Hospital System Supply Identifier | 446473 = Lawson ID"}]},{"description":"COMPONENT GSF FEMORAL SZ 3","code_information":[{"code":"Sx00-5414-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"65595","type":"LOCAL"},{"code":"366331","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65595 = Hospital System Supply Identifier | 366331 = Lawson ID"}]},{"description":"IMP KNEE GSF NP FLEX FEM SIZE","code_information":[{"code":"Sx00-5414-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164570","type":"LOCAL"},{"code":"446474","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164570 = Hospital System Supply Identifier | 446474 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF NP FLX 4-LT","code_information":[{"code":"Sx00-5414-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280133","type":"LOCAL"},{"code":"522203","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280133 = Hospital System Supply Identifier | 522203 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 0 LT","code_information":[{"code":"Sx00-5416-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"285436","type":"LOCAL"},{"code":"526192","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 285436 = Hospital System Supply Identifier | 526192 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 0 RT","code_information":[{"code":"Sx00-5416-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"285437","type":"LOCAL"},{"code":"526193","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 285437 = Hospital System Supply Identifier | 526193 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 1 LT","code_information":[{"code":"Sx00-5416-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"285438","type":"LOCAL"},{"code":"526194","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 285438 = Hospital System Supply Identifier | 526194 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 1 RT","code_information":[{"code":"Sx00-5416-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"285439","type":"LOCAL"},{"code":"526195","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 285439 = Hospital System Supply Identifier | 526195 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 2 LT","code_information":[{"code":"Sx00-5416-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"285440","type":"LOCAL"},{"code":"526196","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 285440 = Hospital System Supply Identifier | 526196 = Lawson ID"}]},{"description":"IMP KNEE GSF POR FLEX FEM SIZE","code_information":[{"code":"Sx00-5416-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164571","type":"LOCAL"},{"code":"446475","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164571 = Hospital System Supply Identifier | 446475 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 3 LT","code_information":[{"code":"Sx00-5416-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"285442","type":"LOCAL"},{"code":"526198","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 285442 = Hospital System Supply Identifier | 526198 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 2 RT","code_information":[{"code":"Sx00-5416-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"285441","type":"LOCAL"},{"code":"526197","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 285441 = Hospital System Supply Identifier | 526197 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 3 RT","code_information":[{"code":"Sx00-5416-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"285443","type":"LOCAL"},{"code":"526199","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 285443 = Hospital System Supply Identifier | 526199 = Lawson ID"}]},{"description":"IMP KNEE FEM GSF POR FLX 4 LT","code_information":[{"code":"Sx00-5416-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"285444","type":"LOCAL"},{"code":"526200","type":"LOCAL"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":3003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 285444 = Hospital System Supply Identifier | 526200 = Lawson ID"}]},{"description":"IMP KNEE PTLA FLX PLY SZ 2 8MM","code_information":[{"code":"Sx00-5418-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162925","type":"LOCAL"},{"code":"441606","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162925 = Hospital System Supply Identifier | 441606 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ0 8","code_information":[{"code":"Sx00-5418-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280134","type":"LOCAL"},{"code":"522204","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280134 = Hospital System Supply Identifier | 522204 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ1 8","code_information":[{"code":"Sx00-5418-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280135","type":"LOCAL"},{"code":"522205","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280135 = Hospital System Supply Identifier | 522205 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ3 8","code_information":[{"code":"Sx00-5418-008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280136","type":"LOCAL"},{"code":"522206","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280136 = Hospital System Supply Identifier | 522206 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ3 10","code_information":[{"code":"Sx00-5418-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280140","type":"LOCAL"},{"code":"522210","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280140 = Hospital System Supply Identifier | 522210 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ2 10","code_information":[{"code":"Sx00-5418-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280139","type":"LOCAL"},{"code":"522209","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280139 = Hospital System Supply Identifier | 522209 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ0 10","code_information":[{"code":"Sx00-5418-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280137","type":"LOCAL"},{"code":"522207","type":"LOCAL"}],"standard_charges":[{"gross_charge":1182.5,"discounted_cash":827.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280137 = Hospital System Supply Identifier | 522207 = Lawson ID"}]},{"description":"IMP KNEE PTELA FLX PLY SZ1 10","code_information":[{"code":"Sx00-5418-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280138","type":"LOCAL"},{"code":"522208","type":"LOCAL"}],"standard_charges":[{"gross_charge":1204.0,"discounted_cash":842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280138 = Hospital System Supply Identifier | 522208 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 11","code_information":[{"code":"Sx00-5423-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280142","type":"LOCAL"},{"code":"522212","type":"LOCAL"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":948.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280142 = Hospital System Supply Identifier | 522212 = Lawson ID"}]},{"description":"IMP FLX PROLONG ART SURF SIZE","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164575","type":"LOCAL"},{"code":"446479","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164575 = Hospital System Supply Identifier | 446479 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 11","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280143","type":"LOCAL"},{"code":"522213","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280143 = Hospital System Supply Identifier | 522213 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 13","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280144","type":"LOCAL"},{"code":"522214","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280144 = Hospital System Supply Identifier | 522214 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 16","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280145","type":"LOCAL"},{"code":"522215","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280145 = Hospital System Supply Identifier | 522215 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0LT 19","code_information":[{"code":"Sx00-5424-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280146","type":"LOCAL"},{"code":"522216","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280146 = Hospital System Supply Identifier | 522216 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ1/2LT 19","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280147","type":"LOCAL"},{"code":"522217","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280147 = Hospital System Supply Identifier | 522217 = Lawson ID"}]},{"description":"IMP FLX PROLONG ART SURF SIZE","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164577","type":"LOCAL"},{"code":"446481","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164577 = Hospital System Supply Identifier | 446481 = Lawson ID"}]},{"description":"IMP FLX PROLONG ART SURF SIZE","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164576","type":"LOCAL"},{"code":"446480","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164576 = Hospital System Supply Identifier | 446480 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PRO .5 LT 11","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162930","type":"LOCAL"},{"code":"441611","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162930 = Hospital System Supply Identifier | 441611 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PRO .5 LT 9","code_information":[{"code":"Sx00-5424-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162929","type":"LOCAL"},{"code":"441610","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162929 = Hospital System Supply Identifier | 441610 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PRO 345 LT13","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162931","type":"LOCAL"},{"code":"441612","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162931 = Hospital System Supply Identifier | 441612 = Lawson ID"}]},{"description":"IMP FLX PRLONG ART SURFACE SZE","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164578","type":"LOCAL"},{"code":"446482","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164578 = Hospital System Supply Identifier | 446482 = Lawson ID"}]},{"description":"IMP FLX PRLONG ART SURF SIZE 3","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164579","type":"LOCAL"},{"code":"446483","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164579 = Hospital System Supply Identifier | 446483 = Lawson ID"}]},{"description":"IMP FLX PRLONG ART SURFACE SIZ","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164580","type":"LOCAL"},{"code":"446484","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164580 = Hospital System Supply Identifier | 446484 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC S3/4/5LT 19","code_information":[{"code":"Sx00-5424-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280148","type":"LOCAL"},{"code":"522218","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280148 = Hospital System Supply Identifier | 522218 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT19","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280152","type":"LOCAL"},{"code":"522222","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280152 = Hospital System Supply Identifier | 522222 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT16","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280151","type":"LOCAL"},{"code":"522221","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280151 = Hospital System Supply Identifier | 522221 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT13","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280150","type":"LOCAL"},{"code":"522220","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280150 = Hospital System Supply Identifier | 522220 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT9","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280149","type":"LOCAL"},{"code":"522219","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280149 = Hospital System Supply Identifier | 522219 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164581","type":"LOCAL"},{"code":"446485","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164581 = Hospital System Supply Identifier | 446485 = Lawson ID"}]},{"description":"SURFACE ARTICULAR SZ 1.2 RT","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"65594","type":"LOCAL"},{"code":"366330","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65594 = Hospital System Supply Identifier | 366330 = Lawson ID"}]},{"description":"SURFACE ARTICULAR SZ 1.2 9MM","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"65597","type":"LOCAL"},{"code":"366333","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65597 = Hospital System Supply Identifier | 366333 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164582","type":"LOCAL"},{"code":"446486","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164582 = Hospital System Supply Identifier | 446486 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164583","type":"LOCAL"},{"code":"446487","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164583 = Hospital System Supply Identifier | 446487 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ1/2-RT19","code_information":[{"code":"Sx00-5424-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280153","type":"LOCAL"},{"code":"522223","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280153 = Hospital System Supply Identifier | 522223 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTCSZ3/4/5-RT19","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280154","type":"LOCAL"},{"code":"522224","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280154 = Hospital System Supply Identifier | 522224 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164586","type":"LOCAL"},{"code":"446490","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164586 = Hospital System Supply Identifier | 446490 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164584","type":"LOCAL"},{"code":"446488","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164584 = Hospital System Supply Identifier | 446488 = Lawson ID"}]},{"description":"IMP FLX PRLONG CONG ART SURF S","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164585","type":"LOCAL"},{"code":"446489","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164585 = Hospital System Supply Identifier | 446489 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PL 345 RT 9","code_information":[{"code":"Sx00-5424-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162932","type":"LOCAL"},{"code":"441613","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162932 = Hospital System Supply Identifier | 441613 = Lawson ID"}]},{"description":"INSERT ARTICULAR 1-2 9MM CONGRUENT UHMWPE KNEE TIBIA RIGHT NATURAL-KNEE II","code_information":[{"code":"Sx00-5425-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"980043","type":"LOCAL"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":698.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 980043 = Hospital System Supply Identifier"}]},{"description":"INSERT ARTICULAR 1-2 11MM CONGRUENT UHMWPE KNEE TIBIA RIGHT NATURAL-KNEE II","code_information":[{"code":"Sx00-5425-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"980044","type":"LOCAL"}],"standard_charges":[{"gross_charge":997.5,"discounted_cash":698.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 980044 = Hospital System Supply Identifier"}]},{"description":"INSERT PROLONG ULTRA 9MM","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"185016","type":"LOCAL"},{"code":"370025","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 185016 = Hospital System Supply Identifier | 370025 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-LT11","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280155","type":"LOCAL"},{"code":"522225","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280155 = Hospital System Supply Identifier | 522225 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-LT13","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280156","type":"LOCAL"},{"code":"522226","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280156 = Hospital System Supply Identifier | 522226 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-LT16","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280157","type":"LOCAL"},{"code":"522227","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280157 = Hospital System Supply Identifier | 522227 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-LT19","code_information":[{"code":"Sx00-5428-010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280158","type":"LOCAL"},{"code":"522228","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280158 = Hospital System Supply Identifier | 522228 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ1/2-LT16","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280159","type":"LOCAL"},{"code":"522229","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280159 = Hospital System Supply Identifier | 522229 = Lawson ID"}]},{"description":"IMP KNEE FLX PROLONG UL CONG A","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164590","type":"LOCAL"},{"code":"446494","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164590 = Hospital System Supply Identifier | 446494 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PL 12 LT 11","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162933","type":"LOCAL"},{"code":"441614","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162933 = Hospital System Supply Identifier | 441614 = Lawson ID"}]},{"description":"INSERT TIB FLEX SZ1-2 9MM LT","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"131079","type":"LOCAL"},{"code":"369326","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 131079 = Hospital System Supply Identifier | 369326 = Lawson ID"}]},{"description":"IMP KNEE GSF NP FLEX FEM SIZE","code_information":[{"code":"Sx00-5428-011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164589","type":"LOCAL"},{"code":"446493","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164589 = Hospital System Supply Identifier | 446493 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PL 345 LT 9","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162934","type":"LOCAL"},{"code":"441615","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162934 = Hospital System Supply Identifier | 441615 = Lawson ID"}]},{"description":"IMP KNEE PRLONG UL CONG ART SU","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164591","type":"LOCAL"},{"code":"446495","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164591 = Hospital System Supply Identifier | 446495 = Lawson ID"}]},{"description":"IMP KNEE PRLONG UL CONG ART SU","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164592","type":"LOCAL"},{"code":"446496","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164592 = Hospital System Supply Identifier | 446496 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTCSZ3/4/5-LT16","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280160","type":"LOCAL"},{"code":"522230","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280160 = Hospital System Supply Identifier | 522230 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164593","type":"LOCAL"},{"code":"446497","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164593 = Hospital System Supply Identifier | 446497 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT16","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280163","type":"LOCAL"},{"code":"522233","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280163 = Hospital System Supply Identifier | 522233 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT19","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280164","type":"LOCAL"},{"code":"522234","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280164 = Hospital System Supply Identifier | 522234 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT13","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280162","type":"LOCAL"},{"code":"522232","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280162 = Hospital System Supply Identifier | 522232 = Lawson ID"}]},{"description":"INSERT PROLONG ULTRA 11MM","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"185014","type":"LOCAL"},{"code":"370012","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 185014 = Hospital System Supply Identifier | 370012 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC SZ00/0-RT9","code_information":[{"code":"Sx00-5428-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280161","type":"LOCAL"},{"code":"522231","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280161 = Hospital System Supply Identifier | 522231 = Lawson ID"}]},{"description":"IMP KNEE ARTC FLX PL 12 RT 9MM","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162935","type":"LOCAL"},{"code":"441616","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162935 = Hospital System Supply Identifier | 441616 = Lawson ID"}]},{"description":"IMPFLX PRLONG UL CONG ART SURF","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164594","type":"LOCAL"},{"code":"446498","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164594 = Hospital System Supply Identifier | 446498 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164595","type":"LOCAL"},{"code":"446499","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164595 = Hospital System Supply Identifier | 446499 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164596","type":"LOCAL"},{"code":"446500","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164596 = Hospital System Supply Identifier | 446500 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164597","type":"LOCAL"},{"code":"446501","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164597 = Hospital System Supply Identifier | 446501 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTCSZ3/4/5-RT19","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280165","type":"LOCAL"},{"code":"522235","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 280165 = Hospital System Supply Identifier | 522235 = Lawson ID"}]},{"description":"SURFACE ARTICULAR SZ 3/4/5","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"65592","type":"LOCAL"},{"code":"366327","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 65592 = Hospital System Supply Identifier | 366327 = Lawson ID"}]},{"description":"SURFACE ARTICULAR SZ 3/4/5 RT","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"185012","type":"LOCAL"},{"code":"366368","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 185012 = Hospital System Supply Identifier | 366368 = Lawson ID"}]},{"description":"IMP FLX PRLONG UL CONG ART SUR","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164598","type":"LOCAL"},{"code":"446503","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164598 = Hospital System Supply Identifier | 446503 = Lawson ID"}]},{"description":"IMP FLX PRLNG UL CONG ART SURF","code_information":[{"code":"Sx00-5428-023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164599","type":"LOCAL"},{"code":"446504","type":"LOCAL"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164599 = Hospital System Supply Identifier | 446504 = Lawson ID"}]},{"description":"IMP FEM CONE AUG SM RT 40","code_information":[{"code":"Sx00-5450-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301577","type":"LOCAL"},{"code":"535786","type":"LOCAL"}],"standard_charges":[{"gross_charge":11238.75,"discounted_cash":7867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301577 = Hospital System Supply Identifier | 535786 = Lawson ID"}]},{"description":"IMP FEM CONE AUG SM RT 30","code_information":[{"code":"Sx00-5450-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301576","type":"LOCAL"},{"code":"535785","type":"LOCAL"}],"standard_charges":[{"gross_charge":11238.75,"discounted_cash":7867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301576 = Hospital System Supply Identifier | 535785 = Lawson ID"}]},{"description":"IMP KNEE FEM CONE TRAB LT 40MM","code_information":[{"code":"Sx00-5450-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304811","type":"LOCAL"},{"code":"452323","type":"LOCAL"}],"standard_charges":[{"gross_charge":11238.75,"discounted_cash":7867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304811 = Hospital System Supply Identifier | 452323 = Lawson ID"}]},{"description":"IMP FEM CONE AUG SM LT 30","code_information":[{"code":"Sx00-5450-012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301575","type":"LOCAL"},{"code":"535784","type":"LOCAL"}],"standard_charges":[{"gross_charge":11238.75,"discounted_cash":7867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301575 = Hospital System Supply Identifier | 535784 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 67X38 RT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301584","type":"LOCAL"},{"code":"535793","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301584 = Hospital System Supply Identifier | 535793 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 55X36 RT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301580","type":"LOCAL"},{"code":"535789","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301580 = Hospital System Supply Identifier | 535789 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 67X38 LT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301583","type":"LOCAL"},{"code":"535792","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301583 = Hospital System Supply Identifier | 535792 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 60X36 RT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301582","type":"LOCAL"},{"code":"535791","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301582 = Hospital System Supply Identifier | 535791 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE LG 60X36 LT","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301581","type":"LOCAL"},{"code":"535790","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301581 = Hospital System Supply Identifier | 535790 = Lawson ID"}]},{"description":"IMP TIB CONE LG TM LT 55X36MM","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"306115","type":"LOCAL"},{"code":"452324","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 306115 = Hospital System Supply Identifier | 452324 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE TM MED 31X31","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"161104","type":"LOCAL"},{"code":"395480","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 161104 = Hospital System Supply Identifier | 395480 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE TM MED 41X34","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304143","type":"LOCAL"},{"code":"427247","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304143 = Hospital System Supply Identifier | 427247 = Lawson ID"}]},{"description":"IMP KNEE CONE LG RT 51X34X25MM","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304129","type":"LOCAL"},{"code":"425965","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304129 = Hospital System Supply Identifier | 425965 = Lawson ID"}]},{"description":"KNEE CONE TIBIAL LARGE LEFT 51","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305902","type":"LOCAL"},{"code":"425149","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 305902 = Hospital System Supply Identifier | 425149 = Lawson ID"}]},{"description":"IMP KNEE TIB MED 35X31MM","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"162179","type":"LOCAL"},{"code":"421386","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 162179 = Hospital System Supply Identifier | 421386 = Lawson ID"}]},{"description":"IMP TIB CONE MED TM 46X34MM","code_information":[{"code":"Sx00-5450-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"173872","type":"LOCAL"},{"code":"446832","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 173872 = Hospital System Supply Identifier | 446832 = Lawson ID"}]},{"description":"IMP FEM CONE AUG MED LT 30","code_information":[{"code":"Sx00-5450-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301585","type":"LOCAL"},{"code":"535794","type":"LOCAL"}],"standard_charges":[{"gross_charge":11238.75,"discounted_cash":7867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301585 = Hospital System Supply Identifier | 535794 = Lawson ID"}]},{"description":"IMP FEM CONE AUG MED RT 30","code_information":[{"code":"Sx00-5450-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301586","type":"LOCAL"},{"code":"535795","type":"LOCAL"}],"standard_charges":[{"gross_charge":11238.75,"discounted_cash":7867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301586 = Hospital System Supply Identifier | 535795 = Lawson ID"}]},{"description":"IMP FEM CONE AUG MED LT 40","code_information":[{"code":"Sx00-5450-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301587","type":"LOCAL"},{"code":"535796","type":"LOCAL"}],"standard_charges":[{"gross_charge":11238.75,"discounted_cash":7867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301587 = Hospital System Supply Identifier | 535796 = Lawson ID"}]},{"description":"IMP FEM CONE AUG MED RT 40","code_information":[{"code":"Sx00-5450-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301588","type":"LOCAL"},{"code":"535797","type":"LOCAL"}],"standard_charges":[{"gross_charge":11238.75,"discounted_cash":7867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301588 = Hospital System Supply Identifier | 535797 = Lawson ID"}]},{"description":"IMP FEM CONE AUG LARGE LT 30","code_information":[{"code":"Sx00-5450-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301591","type":"LOCAL"},{"code":"535800","type":"LOCAL"}],"standard_charges":[{"gross_charge":11238.75,"discounted_cash":7867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301591 = Hospital System Supply Identifier | 535800 = Lawson ID"}]},{"description":"IMP FEM CONE AUG LARGE RT 30","code_information":[{"code":"Sx00-5450-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301592","type":"LOCAL"},{"code":"535801","type":"LOCAL"}],"standard_charges":[{"gross_charge":11238.75,"discounted_cash":7867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301592 = Hospital System Supply Identifier | 535801 = Lawson ID"}]},{"description":"IMP FEM CONE AUG LARGE LT 40","code_information":[{"code":"Sx00-5450-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301593","type":"LOCAL"},{"code":"535802","type":"LOCAL"}],"standard_charges":[{"gross_charge":11238.75,"discounted_cash":7867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301593 = Hospital System Supply Identifier | 535802 = Lawson ID"}]},{"description":"IMP FEM CONE AUG LARGE RT 40","code_information":[{"code":"Sx00-5450-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301594","type":"LOCAL"},{"code":"535803","type":"LOCAL"}],"standard_charges":[{"gross_charge":11238.75,"discounted_cash":7867.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301594 = Hospital System Supply Identifier | 535803 = Lawson ID"}]},{"description":"TM FEM DPHSEAL CONE 30MM SM","code_information":[{"code":"Sx00-5450-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164602","type":"LOCAL"},{"code":"446508","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164602 = Hospital System Supply Identifier | 446508 = Lawson ID"}]},{"description":"TM FEM DIAPHYSEAL CONE 30 SMAL","code_information":[{"code":"Sx00-5450-017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"},{"code":"164601","type":"LOCAL"},{"code":"446507","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 164601 = Hospital System Supply Identifier | 446507 = Lawson ID"}]},{"description":"IMP FEM CONE DPHSEAL MED LT 30","code_information":[{"code":"Sx00-5450-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301597","type":"LOCAL"},{"code":"535806","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301597 = Hospital System Supply Identifier | 535806 = Lawson ID"}]},{"description":"IMP FEM CONE DPHSEAL MED RT 30","code_information":[{"code":"Sx00-5450-018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301598","type":"LOCAL"},{"code":"535807","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301598 = Hospital System Supply Identifier | 535807 = Lawson ID"}]},{"description":"IMP FEM CONE LG TM LT 30MM","code_information":[{"code":"Sx00-5450-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304808","type":"LOCAL"},{"code":"452320","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304808 = Hospital System Supply Identifier | 452320 = Lawson ID"}]},{"description":"IMP FEM CONE DPHSEAL LG RT 30","code_information":[{"code":"Sx00-5450-019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301599","type":"LOCAL"},{"code":"535808","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301599 = Hospital System Supply Identifier | 535808 = Lawson ID"}]},{"description":"IMP FEM CONE MTPHSEAL SM LT 35","code_information":[{"code":"Sx00-5450-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301600","type":"LOCAL"},{"code":"535809","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301600 = Hospital System Supply Identifier | 535809 = Lawson ID"}]},{"description":"IMP FEM CONE MTPHSEAL SM RT 35","code_information":[{"code":"Sx00-5450-020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301601","type":"LOCAL"},{"code":"535810","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301601 = Hospital System Supply Identifier | 535810 = Lawson ID"}]},{"description":"IMP FEM CONE MTPHSEAL MD LT 35","code_information":[{"code":"Sx00-5450-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301602","type":"LOCAL"},{"code":"535811","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301602 = Hospital System Supply Identifier | 535811 = Lawson ID"}]},{"description":"IMP FEM CONE MTPHSEAL MD RT 35","code_information":[{"code":"Sx00-5450-021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301603","type":"LOCAL"},{"code":"535812","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301603 = Hospital System Supply Identifier | 535812 = Lawson ID"}]},{"description":"IMP FEM CONE LG TM LT 35MM","code_information":[{"code":"Sx00-5450-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304809","type":"LOCAL"},{"code":"452321","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304809 = Hospital System Supply Identifier | 452321 = Lawson ID"}]},{"description":"IMP FEM CONE LG TM RT 35MM","code_information":[{"code":"Sx00-5450-022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304810","type":"LOCAL"},{"code":"452322","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304810 = Hospital System Supply Identifier | 452322 = Lawson ID"}]},{"description":"IMP TIB CONE FULL XSM SZ48-15","code_information":[{"code":"Sx00-5450-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301604","type":"LOCAL"},{"code":"535813","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301604 = Hospital System Supply Identifier | 535813 = Lawson ID"}]},{"description":"IMP TIB CONE FULL SM SZ52-15","code_information":[{"code":"Sx00-5450-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301605","type":"LOCAL"},{"code":"535814","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301605 = Hospital System Supply Identifier | 535814 = Lawson ID"}]},{"description":"IMP TIB CONE SZ59 STP 30/15 LT","code_information":[{"code":"Sx00-5450-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301607","type":"LOCAL"},{"code":"535816","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301607 = Hospital System Supply Identifier | 535816 = Lawson ID"}]},{"description":"IMP TIB CONE SZ59 STP 15/30 RT","code_information":[{"code":"Sx00-5450-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301608","type":"LOCAL"},{"code":"535817","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301608 = Hospital System Supply Identifier | 535817 = Lawson ID"}]},{"description":"IMP TIB CONE STD SZ59 30MM MED","code_information":[{"code":"Sx00-5450-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"39260","type":"LOCAL"},{"code":"353708","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 39260 = Hospital System Supply Identifier | 353708 = Lawson ID"}]},{"description":"IMP TIB CONE FULL MED SZ59-30","code_information":[{"code":"Sx00-5450-059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301606","type":"LOCAL"},{"code":"535815","type":"LOCAL"}],"standard_charges":[{"gross_charge":10669.23,"discounted_cash":7468.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301606 = Hospital System Supply Identifier | 535815 = Lawson ID"}]},{"description":"IMP TIB CONE SZ67 STP 30/15 LT","code_information":[{"code":"Sx00-5450-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301610","type":"LOCAL"},{"code":"535819","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301610 = Hospital System Supply Identifier | 535819 = Lawson ID"}]},{"description":"IMP TIB CONE SZ67 STP 15/30 LT","code_information":[{"code":"Sx00-5450-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301611","type":"LOCAL"},{"code":"535820","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301611 = Hospital System Supply Identifier | 535820 = Lawson ID"}]},{"description":"IMP KNEE TIB CONE TRAB SZ67 15","code_information":[{"code":"Sx00-5450-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304812","type":"LOCAL"},{"code":"452325","type":"LOCAL"}],"standard_charges":[{"gross_charge":8940.0,"discounted_cash":6258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304812 = Hospital System Supply Identifier | 452325 = Lawson ID"}]},{"description":"IMP TIB CONE FULL LG SZ67-30","code_information":[{"code":"Sx00-5450-067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301609","type":"LOCAL"},{"code":"535818","type":"LOCAL"}],"standard_charges":[{"gross_charge":10669.23,"discounted_cash":7468.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 301609 = Hospital System Supply Identifier | 535818 = Lawson ID"}]},{"description":"BUR TIB CONE LG","code_information":[{"code":"Sx00-5452-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"304600","type":"LOCAL"},{"code":"447589","type":"LOCAL"}],"standard_charges":[{"gross_charge":1264.2,"discounted_cash":884.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 304600 = Hospital System Supply Identifier | 447589 = Lawson ID"}]},{"description":"PLATE EXTERNAL FIXATION BURR TEMPLATE","code_information":[{"code":"Sx00-5452-013","type":"CDM"},{"code":"272","type":"RC"},{"code":"981805","type":"LOCAL"}],"standard_charges":[{"gross_charge":3252.37,"discounted_cash":2276.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 981805 = Hospital System Supply Identifier"}]},{"description":"ALGRFT CARTLG NAT TISS DENOVO","code_information":[{"code":"Sx00-5606-000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"},{"code":"171683","type":"LOCAL"},{"code":"453691","type":"LOCAL"}],"standard_charges":[{"gross_charge":12609.0,"discounted_cash":8826.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 171683 = Hospital System Supply Identifier | 453691 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5750-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"6665","type":"LOCAL"},{"code":"354410","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 6665 = Hospital System Supply Identifier | 354410 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZC","code_information":[{"code":"Sx00-5750-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"6666","type":"LOCAL"},{"code":"354411","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 6666 = Hospital System Supply Identifier | 354411 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5750-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"6669","type":"LOCAL"},{"code":"354414","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 6669 = Hospital System Supply Identifier | 354414 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZC","code_information":[{"code":"Sx00-5750-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"6670","type":"LOCAL"},{"code":"354416","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 6670 = Hospital System Supply Identifier | 354416 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5750-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"5178","type":"LOCAL"},{"code":"343824","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5178 = Hospital System Supply Identifier | 343824 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN LT SZD","code_information":[{"code":"Sx00-5750-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"5747","type":"LOCAL"},{"code":"348627","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WSJ LOCATION | 5747 = Hospital System Supply Identifier | 348627 = Lawson ID"}]},{"description":"IMP KNEE FEM COMP NXGN RT SZD","code_information":[{"code":"Sx00-5750-014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"31522","type":"LOCAL"},{"code":"330181","type":"LOCAL"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":2205.0,"setting":"both"