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For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Marni Leonard"},"financial_aid_policy":["48% off of standard gross charges."],"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Premera All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Premera Heritage Signature All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Premera Lifewise Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Premera Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Regence All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Regence Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield","plan_name":"Regence Uniform Medical Plan Other Commercial Plan","description":"The modified price is presented in the standard charge 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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":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 134331 = Hospital System Supply Identifier | 208827 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 5001-60","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134332","type":"LOCAL"},{"code":"208828","type":"LOCAL"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 134332 = Hospital System Supply Identifier | 208828 = Lawson ID"}]},{"description":"LINER MULTIPOLAR 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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":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 280086 = Hospital System Supply Identifier | 522145 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 60X32MM","code_information":[{"code":"Sx00-5001-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280087","type":"LOCAL"},{"code":"522146","type":"LOCAL"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 280087 = Hospital System Supply Identifier | 522146 = Lawson ID"}]},{"description":"SHELL MULTIPOLAR 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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":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH 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":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 280090 = Hospital System Supply Identifier | 522149 = Lawson ID"}]},{"description":"IMP HIP SHELL MULTPLR 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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":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 280092 = Hospital System Supply Identifier | 522151 = Lawson ID"}]},{"description":"IMP HIP ACET LNR BPLR 68X32MM","code_information":[{"code":"Sx00-5001-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280093","type":"LOCAL"},{"code":"522152","type":"LOCAL"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 280093 = Hospital System Supply Identifier | 522152 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 70MM","code_information":[{"code":"Sx00-5001-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"280094","type":"LOCAL"},{"code":"522153","type":"LOCAL"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH 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":1500.0,"discounted_cash":780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303147 = Hospital System Supply Identifier | 408144 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL BPLR 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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":665.35,"discounted_cash":345.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH 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":120.24,"discounted_cash":62.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 12394 = Hospital System Supply Identifier | 237595 = Lawson ID"}]},{"description":"SYSTEM BONE CEMENT NSTRL 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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":15691.68,"discounted_cash":8159.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH 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":15691.68,"discounted_cash":8159.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 30969 = Hospital System Supply Identifier | 324074 = Lawson ID"}]},{"description":"IMP KNEE TIB INS SURF 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YE","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"164630","type":"LOCAL"},{"code":"446541","type":"LOCAL"}],"standard_charges":[{"gross_charge":11082.5,"discounted_cash":5762.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 164630 = Hospital System Supply Identifier | 446541 = Lawson ID"}]},{"description":"IMP KNEE SURF ARTC CD 3-4 23","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"301056","type":"LOCAL"},{"code":"535265","type":"LOCAL"}],"standard_charges":[{"gross_charge":11082.5,"discounted_cash":5762.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 301056 = Hospital System Supply Identifier | 535265 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 17MM","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"31079","type":"LOCAL"},{"code":"324227","type":"LOCAL"}],"standard_charges":[{"gross_charge":11082.5,"discounted_cash":5762.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 31079 = Hospital System Supply Identifier | 324227 = Lawson ID"}]},{"description":"IMP TIB INS NXGN 3-4 10MM","code_information":[{"code":"Sx00-5994-030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"31078","type":"LOCAL"},{"code":"324226","type":"LOCAL"}],"standard_charges":[{"gross_charge":11082.5,"discounted_cash":5762.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 31078 = Hospital System Supply Identifier | 324226 = Lawson ID"}]},{"description":"IMP TIB INS POST NXGN SZ3-4 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50/52/54X22","code_information":[{"code":"Sx00-6110-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281006","type":"LOCAL"},{"code":"522758","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281006 = Hospital System Supply Identifier | 522758 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 50/52/54X26","code_information":[{"code":"Sx00-6110-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281007","type":"LOCAL"},{"code":"522759","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281007 = Hospital System Supply Identifier | 522759 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 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62X32","code_information":[{"code":"Sx00-6110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281024","type":"LOCAL"},{"code":"522776","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281024 = Hospital System Supply Identifier | 522776 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 62X22","code_information":[{"code":"Sx00-6110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281021","type":"LOCAL"},{"code":"522773","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281021 = Hospital System Supply Identifier | 522773 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 62X26","code_information":[{"code":"Sx00-6110-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281022","type":"LOCAL"},{"code":"522774","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281022 = Hospital System Supply Identifier | 522774 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 64X22","code_information":[{"code":"Sx00-6110-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281025","type":"LOCAL"},{"code":"522777","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281025 = Hospital System Supply Identifier | 522777 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 64X26","code_information":[{"code":"Sx00-6110-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281026","type":"LOCAL"},{"code":"522778","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281026 = Hospital System Supply Identifier | 522778 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 64X28","code_information":[{"code":"Sx00-6110-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281027","type":"LOCAL"},{"code":"522779","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281027 = Hospital System Supply Identifier | 522779 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 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66X26","code_information":[{"code":"Sx00-6110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281030","type":"LOCAL"},{"code":"522782","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281030 = Hospital System Supply Identifier | 522782 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 66X28","code_information":[{"code":"Sx00-6110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281031","type":"LOCAL"},{"code":"522783","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281031 = Hospital System Supply Identifier | 522783 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 66X32","code_information":[{"code":"Sx00-6110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281032","type":"LOCAL"},{"code":"522784","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281032 = Hospital System Supply Identifier | 522784 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 68X32","code_information":[{"code":"Sx00-6110-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281036","type":"LOCAL"},{"code":"522788","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281036 = Hospital System Supply Identifier | 522788 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 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68X22","code_information":[{"code":"Sx00-6110-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281033","type":"LOCAL"},{"code":"522785","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281033 = Hospital System Supply Identifier | 522785 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 70X22","code_information":[{"code":"Sx00-6110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281037","type":"LOCAL"},{"code":"522789","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281037 = Hospital System Supply Identifier | 522789 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 70X26","code_information":[{"code":"Sx00-6110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281038","type":"LOCAL"},{"code":"522790","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281038 = Hospital System Supply Identifier | 522790 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 70X28","code_information":[{"code":"Sx00-6110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281039","type":"LOCAL"},{"code":"522791","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281039 = Hospital System Supply Identifier | 522791 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 70X32","code_information":[{"code":"Sx00-6110-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281040","type":"LOCAL"},{"code":"522792","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281040 = Hospital System Supply Identifier | 522792 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 72X32","code_information":[{"code":"Sx00-6110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281044","type":"LOCAL"},{"code":"522796","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281044 = Hospital System Supply Identifier | 522796 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 72X22","code_information":[{"code":"Sx00-6110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281041","type":"LOCAL"},{"code":"522793","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281041 = Hospital System Supply Identifier | 522793 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 72X26","code_information":[{"code":"Sx00-6110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281042","type":"LOCAL"},{"code":"522794","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281042 = Hospital System Supply Identifier | 522794 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 72X28","code_information":[{"code":"Sx00-6110-072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281043","type":"LOCAL"},{"code":"522795","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281043 = Hospital System Supply Identifier | 522795 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 74X32","code_information":[{"code":"Sx00-6110-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281048","type":"LOCAL"},{"code":"522800","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281048 = Hospital System Supply Identifier | 522800 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 74X28","code_information":[{"code":"Sx00-6110-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281047","type":"LOCAL"},{"code":"522799","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281047 = Hospital System Supply Identifier | 522799 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 74X26","code_information":[{"code":"Sx00-6110-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281046","type":"LOCAL"},{"code":"522798","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281046 = Hospital System Supply Identifier | 522798 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 74X22","code_information":[{"code":"Sx00-6110-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281045","type":"LOCAL"},{"code":"522797","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281045 = Hospital System Supply Identifier | 522797 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 76X22","code_information":[{"code":"Sx00-6110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281049","type":"LOCAL"},{"code":"522801","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281049 = Hospital System Supply Identifier | 522801 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 76X26","code_information":[{"code":"Sx00-6110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281050","type":"LOCAL"},{"code":"522802","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281050 = Hospital System Supply Identifier | 522802 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 76X28","code_information":[{"code":"Sx00-6110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281051","type":"LOCAL"},{"code":"522803","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281051 = Hospital System Supply Identifier | 522803 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 76X32","code_information":[{"code":"Sx00-6110-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281052","type":"LOCAL"},{"code":"522804","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281052 = Hospital System Supply Identifier | 522804 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 78X28","code_information":[{"code":"Sx00-6110-078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281055","type":"LOCAL"},{"code":"522807","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281055 = Hospital System Supply Identifier | 522807 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 78X32","code_information":[{"code":"Sx00-6110-078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281056","type":"LOCAL"},{"code":"522808","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281056 = Hospital System Supply Identifier | 522808 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 78X22","code_information":[{"code":"Sx00-6110-078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281053","type":"LOCAL"},{"code":"522805","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281053 = Hospital System Supply Identifier | 522805 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 78X26","code_information":[{"code":"Sx00-6110-078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281054","type":"LOCAL"},{"code":"522806","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281054 = Hospital System Supply Identifier | 522806 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 80MM","code_information":[{"code":"Sx00-6110-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303150","type":"LOCAL"},{"code":"408147","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303150 = Hospital System Supply Identifier | 408147 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 80X22","code_information":[{"code":"Sx00-6110-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281057","type":"LOCAL"},{"code":"522809","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281057 = Hospital System Supply Identifier | 522809 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 80X26","code_information":[{"code":"Sx00-6110-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281058","type":"LOCAL"},{"code":"522810","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281058 = Hospital System Supply Identifier | 522810 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 10D 80X32","code_information":[{"code":"Sx00-6110-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281059","type":"LOCAL"},{"code":"522811","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281059 = Hospital System Supply Identifier | 522811 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 36X22","code_information":[{"code":"Sx00-6120-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281060","type":"LOCAL"},{"code":"522812","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281060 = Hospital System Supply Identifier | 522812 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 38X22","code_information":[{"code":"Sx00-6120-038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281061","type":"LOCAL"},{"code":"522813","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281061 = Hospital System Supply Identifier | 522813 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 40X22","code_information":[{"code":"Sx00-6120-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281062","type":"LOCAL"},{"code":"522814","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281062 = Hospital System Supply Identifier | 522814 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 42X26","code_information":[{"code":"Sx00-6120-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281064","type":"LOCAL"},{"code":"522816","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281064 = Hospital System Supply Identifier | 522816 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 42X22","code_information":[{"code":"Sx00-6120-042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281063","type":"LOCAL"},{"code":"522815","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281063 = Hospital System Supply Identifier | 522815 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 44X28","code_information":[{"code":"Sx00-6120-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281067","type":"LOCAL"},{"code":"522819","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281067 = Hospital System Supply Identifier | 522819 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 44X22","code_information":[{"code":"Sx00-6120-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281065","type":"LOCAL"},{"code":"522817","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281065 = Hospital System Supply Identifier | 522817 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 44X26","code_information":[{"code":"Sx00-6120-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281066","type":"LOCAL"},{"code":"522818","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281066 = Hospital System Supply Identifier | 522818 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 46X22","code_information":[{"code":"Sx00-6120-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281068","type":"LOCAL"},{"code":"522820","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281068 = Hospital System Supply Identifier | 522820 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 46X26","code_information":[{"code":"Sx00-6120-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281069","type":"LOCAL"},{"code":"522821","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281069 = Hospital System Supply Identifier | 522821 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 46X28","code_information":[{"code":"Sx00-6120-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281070","type":"LOCAL"},{"code":"522822","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281070 = Hospital System Supply Identifier | 522822 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 48X22","code_information":[{"code":"Sx00-6120-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281071","type":"LOCAL"},{"code":"522823","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281071 = Hospital System Supply Identifier | 522823 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 48X26","code_information":[{"code":"Sx00-6120-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281072","type":"LOCAL"},{"code":"522824","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281072 = Hospital System Supply Identifier | 522824 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 48X28","code_information":[{"code":"Sx00-6120-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281073","type":"LOCAL"},{"code":"522825","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281073 = Hospital System Supply Identifier | 522825 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 48X32","code_information":[{"code":"Sx00-6120-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281074","type":"LOCAL"},{"code":"522826","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281074 = Hospital System Supply Identifier | 522826 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 50/52/54X22","code_information":[{"code":"Sx00-6120-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281075","type":"LOCAL"},{"code":"522827","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281075 = Hospital System Supply Identifier | 522827 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 50/52/54X26","code_information":[{"code":"Sx00-6120-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281076","type":"LOCAL"},{"code":"522828","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281076 = Hospital System Supply Identifier | 522828 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 50/52/54X28","code_information":[{"code":"Sx00-6120-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281077","type":"LOCAL"},{"code":"522829","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281077 = Hospital System Supply Identifier | 522829 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 50/52/54X32","code_information":[{"code":"Sx00-6120-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281078","type":"LOCAL"},{"code":"522830","type":"LOCAL"}],"standard_charges":[{"gross_charge":4470.0,"discounted_cash":2324.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281078 = Hospital System Supply Identifier | 522830 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 56X22","code_information":[{"code":"Sx00-6120-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281079","type":"LOCAL"},{"code":"522831","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281079 = Hospital System Supply Identifier | 522831 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 56X26","code_information":[{"code":"Sx00-6120-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281080","type":"LOCAL"},{"code":"522832","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281080 = Hospital System Supply Identifier | 522832 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 56X28","code_information":[{"code":"Sx00-6120-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281081","type":"LOCAL"},{"code":"522833","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281081 = Hospital System Supply Identifier | 522833 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 56X32","code_information":[{"code":"Sx00-6120-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281082","type":"LOCAL"},{"code":"522834","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281082 = Hospital System Supply Identifier | 522834 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 58X32","code_information":[{"code":"Sx00-6120-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281086","type":"LOCAL"},{"code":"522838","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281086 = Hospital System Supply Identifier | 522838 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 58X28","code_information":[{"code":"Sx00-6120-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281085","type":"LOCAL"},{"code":"522837","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281085 = Hospital System Supply Identifier | 522837 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 58X26","code_information":[{"code":"Sx00-6120-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281084","type":"LOCAL"},{"code":"522836","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281084 = Hospital System Supply Identifier | 522836 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 58X22","code_information":[{"code":"Sx00-6120-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281083","type":"LOCAL"},{"code":"522835","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281083 = Hospital System Supply Identifier | 522835 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 60X32","code_information":[{"code":"Sx00-6120-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281090","type":"LOCAL"},{"code":"522842","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281090 = Hospital System Supply Identifier | 522842 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 60X28","code_information":[{"code":"Sx00-6120-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281089","type":"LOCAL"},{"code":"522841","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281089 = Hospital System Supply Identifier | 522841 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 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74X22","code_information":[{"code":"Sx00-6120-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281115","type":"LOCAL"},{"code":"522867","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281115 = Hospital System Supply Identifier | 522867 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 74X26","code_information":[{"code":"Sx00-6120-074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281116","type":"LOCAL"},{"code":"522868","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281116 = Hospital System Supply Identifier | 522868 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 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76X22","code_information":[{"code":"Sx00-6120-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281119","type":"LOCAL"},{"code":"522871","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281119 = Hospital System Supply Identifier | 522871 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 76X26","code_information":[{"code":"Sx00-6120-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281120","type":"LOCAL"},{"code":"522872","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281120 = Hospital System Supply Identifier | 522872 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 78X28","code_information":[{"code":"Sx00-6120-078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281125","type":"LOCAL"},{"code":"522877","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281125 = Hospital System Supply Identifier | 522877 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 78X32","code_information":[{"code":"Sx00-6120-078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"281126","type":"LOCAL"},{"code":"522878","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 281126 = Hospital System Supply Identifier | 522878 = Lawson ID"}]},{"description":"IMP HIP ACET LNR STD 20D 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28X44MM","code_information":[{"code":"Sx00-6310-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303169","type":"LOCAL"},{"code":"408166","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303169 = Hospital System Supply Identifier | 408166 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X44MM","code_information":[{"code":"Sx00-6310-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303168","type":"LOCAL"},{"code":"408165","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303168 = Hospital System Supply Identifier | 408165 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-44-22","code_information":[{"code":"Sx00-6310-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305436","type":"LOCAL"},{"code":"204639","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305436 = Hospital System Supply Identifier | 204639 = Lawson ID"}]},{"description":"LINER 10 TRILOGY 6310-46-22","code_information":[{"code":"Sx00-6310-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305490","type":"LOCAL"},{"code":"208601","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305490 = Hospital System Supply Identifier | 208601 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 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6310-48-28","code_information":[{"code":"Sx00-6310-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305423","type":"LOCAL"},{"code":"203488","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305423 = Hospital System Supply Identifier | 203488 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 26X48MM","code_information":[{"code":"Sx00-6310-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303172","type":"LOCAL"},{"code":"408169","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303172 = Hospital System Supply Identifier | 408169 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 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44X28","code_information":[{"code":"Sx00-6320-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"283362","type":"LOCAL"},{"code":"523267","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 283362 = Hospital System Supply Identifier | 523267 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 44X22","code_information":[{"code":"Sx00-6320-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"283360","type":"LOCAL"},{"code":"523265","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 283360 = Hospital System Supply Identifier | 523265 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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76X22","code_information":[{"code":"Sx00-6320-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"283408","type":"LOCAL"},{"code":"523313","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 283408 = Hospital System Supply Identifier | 523313 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 76X26","code_information":[{"code":"Sx00-6320-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"283409","type":"LOCAL"},{"code":"523314","type":"LOCAL"}],"standard_charges":[{"gross_charge":4470.0,"discounted_cash":2324.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 283409 = Hospital System Supply Identifier | 523314 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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80X32","code_information":[{"code":"Sx00-6320-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"283419","type":"LOCAL"},{"code":"523324","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 283419 = Hospital System Supply Identifier | 523324 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 80X28","code_information":[{"code":"Sx00-6320-080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"283418","type":"LOCAL"},{"code":"523323","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 283418 = Hospital System Supply Identifier | 523323 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 20D 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32X58MM","code_information":[{"code":"Sx00-6334-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"7916","type":"LOCAL"},{"code":"361133","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 7916 = Hospital System Supply Identifier | 361133 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 36X60MM","code_information":[{"code":"Sx00-6334-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"31141","type":"LOCAL"},{"code":"324316","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 31141 = Hospital System Supply Identifier | 324316 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 36X62MM","code_information":[{"code":"Sx00-6334-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"6509","type":"LOCAL"},{"code":"353434","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 6509 = Hospital System Supply Identifier | 353434 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 36X64MM","code_information":[{"code":"Sx00-6334-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"31733","type":"LOCAL"},{"code":"331049","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 31733 = Hospital System Supply Identifier | 331049 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 36X66MM","code_information":[{"code":"Sx00-6334-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303393","type":"LOCAL"},{"code":"411671","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303393 = Hospital System Supply Identifier | 411671 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 36X68MM","code_information":[{"code":"Sx00-6334-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303179","type":"LOCAL"},{"code":"408176","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303179 = Hospital System Supply Identifier | 408176 = Lawson ID"}]},{"description":"IMP HIP ACET LNR TLGY 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44X28","code_information":[{"code":"Sx00-6341-044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303180","type":"LOCAL"},{"code":"408177","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303180 = Hospital System Supply Identifier | 408177 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 7MM OFF 46X28","code_information":[{"code":"Sx00-6341-046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"283427","type":"LOCAL"},{"code":"523332","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 283427 = Hospital System Supply Identifier | 523332 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 7MM OFF 32X48","code_information":[{"code":"Sx00-6341-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303394","type":"LOCAL"},{"code":"411672","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303394 = Hospital System Supply Identifier | 411672 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 7MM OFF 48X28","code_information":[{"code":"Sx00-6341-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303181","type":"LOCAL"},{"code":"408178","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303181 = Hospital System Supply Identifier | 408178 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 28M","code_information":[{"code":"Sx00-6341-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305476","type":"LOCAL"},{"code":"206459","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305476 = Hospital System Supply Identifier | 206459 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET","code_information":[{"code":"Sx00-6341-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134297","type":"LOCAL"},{"code":"208732","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 134297 = Hospital System Supply Identifier | 208732 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 28M","code_information":[{"code":"Sx00-6341-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305477","type":"LOCAL"},{"code":"206460","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305477 = Hospital System Supply Identifier | 206460 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 32M","code_information":[{"code":"Sx00-6341-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"160970","type":"LOCAL"},{"code":"206465","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 160970 = Hospital System Supply Identifier | 206465 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 28M","code_information":[{"code":"Sx00-6341-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305478","type":"LOCAL"},{"code":"206461","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305478 = Hospital System Supply Identifier | 206461 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 32M","code_information":[{"code":"Sx00-6341-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305482","type":"LOCAL"},{"code":"206466","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305482 = Hospital System Supply Identifier | 206466 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 32M","code_information":[{"code":"Sx00-6341-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305483","type":"LOCAL"},{"code":"206467","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305483 = Hospital System Supply Identifier | 206467 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 28M","code_information":[{"code":"Sx00-6341-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305479","type":"LOCAL"},{"code":"206462","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305479 = Hospital System Supply Identifier | 206462 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 32M","code_information":[{"code":"Sx00-6341-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305484","type":"LOCAL"},{"code":"206468","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305484 = Hospital System Supply Identifier | 206468 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 28M","code_information":[{"code":"Sx00-6341-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305480","type":"LOCAL"},{"code":"206463","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305480 = Hospital System Supply Identifier | 206463 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 28M","code_information":[{"code":"Sx00-6341-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305481","type":"LOCAL"},{"code":"206464","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305481 = Hospital System Supply Identifier | 206464 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 32M","code_information":[{"code":"Sx00-6341-064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134186","type":"LOCAL"},{"code":"206610","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 134186 = Hospital System Supply Identifier | 206610 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 32M","code_information":[{"code":"Sx00-6341-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305485","type":"LOCAL"},{"code":"206469","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305485 = Hospital System Supply Identifier | 206469 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 7MM OFF 66X28","code_information":[{"code":"Sx00-6341-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303182","type":"LOCAL"},{"code":"408179","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303182 = Hospital System Supply Identifier | 408179 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 32M","code_information":[{"code":"Sx00-6341-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305486","type":"LOCAL"},{"code":"206470","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305486 = Hospital System Supply Identifier | 206470 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 7MM OFF 68X28","code_information":[{"code":"Sx00-6341-068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303183","type":"LOCAL"},{"code":"408180","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303183 = Hospital System Supply Identifier | 408180 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 7MM OFF 70X28","code_information":[{"code":"Sx00-6341-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"303184","type":"LOCAL"},{"code":"408181","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 303184 = Hospital System Supply Identifier | 408181 = Lawson ID"}]},{"description":"LINER LONGEVITY 7MM OFFSET 32M","code_information":[{"code":"Sx00-6341-070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"305487","type":"LOCAL"},{"code":"206471","type":"LOCAL"}],"standard_charges":[{"gross_charge":4097.5,"discounted_cash":2130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 305487 = Hospital System Supply Identifier | 206471 = Lawson ID"}]},{"description":"IMP HIP FEM HD 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62MM","code_information":[{"code":"Sx00-7053-062","type":"CDM"},{"code":"272","type":"RC"},{"code":"26967","type":"LOCAL"},{"code":"310998","type":"LOCAL"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2169.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 26967 = Hospital System Supply Identifier | 310998 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 62MM","code_information":[{"code":"Sx00-7053-062","type":"CDM"},{"code":"272","type":"RC"},{"code":"26960","type":"LOCAL"},{"code":"310991","type":"LOCAL"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2169.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 26960 = Hospital System Supply Identifier | 310991 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 64MM","code_information":[{"code":"Sx00-7053-064","type":"CDM"},{"code":"272","type":"RC"},{"code":"37584","type":"LOCAL"},{"code":"210147","type":"LOCAL"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2169.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 37584 = Hospital System Supply Identifier | 210147 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 64MM","code_information":[{"code":"Sx00-7053-064","type":"CDM"},{"code":"272","type":"RC"},{"code":"37583","type":"LOCAL"},{"code":"210146","type":"LOCAL"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2169.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 37583 = Hospital System Supply Identifier | 210146 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 66MM","code_information":[{"code":"Sx00-7053-066","type":"CDM"},{"code":"272","type":"RC"},{"code":"26961","type":"LOCAL"},{"code":"310992","type":"LOCAL"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2169.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 26961 = Hospital System Supply Identifier | 310992 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 66MM","code_information":[{"code":"Sx00-7053-066","type":"CDM"},{"code":"272","type":"RC"},{"code":"26968","type":"LOCAL"},{"code":"310999","type":"LOCAL"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2169.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 26968 = Hospital System Supply Identifier | 310999 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 68MM","code_information":[{"code":"Sx00-7053-068","type":"CDM"},{"code":"272","type":"RC"},{"code":"26962","type":"LOCAL"},{"code":"310993","type":"LOCAL"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2169.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 26962 = Hospital System Supply Identifier | 310993 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 68MM","code_information":[{"code":"Sx00-7053-068","type":"CDM"},{"code":"272","type":"RC"},{"code":"26969","type":"LOCAL"},{"code":"311000","type":"LOCAL"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2169.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 26969 = Hospital System Supply Identifier | 311000 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 70MM","code_information":[{"code":"Sx00-7053-070","type":"CDM"},{"code":"272","type":"RC"},{"code":"7930","type":"LOCAL"},{"code":"361331","type":"LOCAL"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2169.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 7930 = Hospital System Supply Identifier | 361331 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 70MM","code_information":[{"code":"Sx00-7053-070","type":"CDM"},{"code":"272","type":"RC"},{"code":"7932","type":"LOCAL"},{"code":"361333","type":"LOCAL"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2169.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 7932 = Hospital System Supply Identifier | 361333 = Lawson ID"}]},{"description":"BLADE EXPLANT TRUN 72MM","code_information":[{"code":"Sx00-7053-072","type":"CDM"},{"code":"272","type":"RC"},{"code":"7931","type":"LOCAL"},{"code":"361332","type":"LOCAL"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2169.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 7931 = Hospital System Supply Identifier | 361332 = Lawson ID"}]},{"description":"BLADE EXPLANT FULL 72MM","code_information":[{"code":"Sx00-7053-072","type":"CDM"},{"code":"272","type":"RC"},{"code":"7933","type":"LOCAL"},{"code":"361334","type":"LOCAL"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2169.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 7933 = Hospital System Supply Identifier | 361334 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL 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62/64X28","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299940","type":"LOCAL"},{"code":"534149","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299940 = Hospital System Supply Identifier | 534149 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 62/64X32","code_information":[{"code":"Sx00-7105-062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299941","type":"LOCAL"},{"code":"534150","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299941 = Hospital System Supply Identifier | 534150 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 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76-80X32","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299951","type":"LOCAL"},{"code":"534160","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299951 = Hospital System Supply Identifier | 534160 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X36","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299952","type":"LOCAL"},{"code":"534161","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299952 = Hospital System Supply Identifier | 534161 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 0D 76-80X40","code_information":[{"code":"Sx00-7105-076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299953","type":"LOCAL"},{"code":"534162","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299953 = Hospital System Supply Identifier | 534162 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 48X28","code_information":[{"code":"Sx00-7110-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299954","type":"LOCAL"},{"code":"534163","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299954 = Hospital System Supply Identifier | 534163 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 50X28","code_information":[{"code":"Sx00-7110-050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299955","type":"LOCAL"},{"code":"534164","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299955 = Hospital System Supply Identifier | 534164 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 52X28","code_information":[{"code":"Sx00-7110-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299956","type":"LOCAL"},{"code":"534165","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299956 = Hospital System Supply Identifier | 534165 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 32X54MM","code_information":[{"code":"Sx00-7110-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304731","type":"LOCAL"},{"code":"452194","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 304731 = Hospital System Supply Identifier | 452194 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 54X28","code_information":[{"code":"Sx00-7110-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299957","type":"LOCAL"},{"code":"534166","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299957 = Hospital System Supply Identifier | 534166 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 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66-70X28","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299967","type":"LOCAL"},{"code":"534176","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299967 = Hospital System Supply Identifier | 534176 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 66-70X32","code_information":[{"code":"Sx00-7110-066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299968","type":"LOCAL"},{"code":"534177","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299968 = Hospital System Supply Identifier | 534177 = Lawson ID"}]},{"description":"IMP HIP ACET LNR 10D 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54X32MM","code_information":[{"code":"Sx00-7115-054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304549","type":"LOCAL"},{"code":"443651","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 304549 = Hospital System Supply Identifier | 443651 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 56X32","code_information":[{"code":"Sx00-7115-056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299978","type":"LOCAL"},{"code":"534187","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299978 = Hospital System Supply Identifier | 534187 = Lawson ID"}]},{"description":"IMP HIP LNR CNSTRN CEM 36X58MM","code_information":[{"code":"Sx00-7115-058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"304729","type":"LOCAL"},{"code":"452184","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 304729 = Hospital System Supply Identifier | 452184 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 60X36","code_information":[{"code":"Sx00-7115-060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"299979","type":"LOCAL"},{"code":"534188","type":"LOCAL"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":5948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 299979 = Hospital System Supply Identifier | 534188 = Lawson ID"}]},{"description":"IMP HIP ACET SHELL TM 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7818-48","code_information":[{"code":"Sx00-7818-048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53376","type":"LOCAL"},{"code":"203838","type":"LOCAL"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1092.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 53376 = Hospital System Supply Identifier | 203838 = Lawson ID"}]},{"description":"IMP HEAD UNIPOLAR 7818-49","code_information":[{"code":"Sx00-7818-049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53377","type":"LOCAL"},{"code":"203839","type":"LOCAL"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1092.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 53377 = Hospital System Supply Identifier | 203839 = Lawson ID"}]},{"description":"IMP HEAD UNIPOLAR 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7818-52","code_information":[{"code":"Sx00-7818-052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134028","type":"LOCAL"},{"code":"203842","type":"LOCAL"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1092.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 134028 = Hospital System Supply Identifier | 203842 = Lawson ID"}]},{"description":"IMP HEAD UNIPOLAR 7818-53","code_information":[{"code":"Sx00-7818-053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134029","type":"LOCAL"},{"code":"203843","type":"LOCAL"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1092.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 134029 = Hospital System Supply Identifier | 203843 = Lawson ID"}]},{"description":"IMP HEAD UNIPOLAR 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7859-15","code_information":[{"code":"Sx00-7859-015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"60226","type":"LOCAL"},{"code":"203797","type":"LOCAL"}],"standard_charges":[{"gross_charge":376.5,"discounted_cash":195.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 60226 = Hospital System Supply Identifier | 203797 = Lawson ID"}]},{"description":"IMP DISTAL CENT 7859-16","code_information":[{"code":"Sx00-7859-016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134019","type":"LOCAL"},{"code":"203798","type":"LOCAL"}],"standard_charges":[{"gross_charge":376.5,"discounted_cash":195.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 134019 = Hospital System Supply Identifier | 203798 = Lawson ID"}]},{"description":"IMP DISTAL CENT 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8018-36-02","code_information":[{"code":"Sx00-8018-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53410","type":"LOCAL"},{"code":"207592","type":"LOCAL"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":1170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 53410 = Hospital System Supply Identifier | 207592 = Lawson ID"}]},{"description":"HEAD 36MM 8018-36-03","code_information":[{"code":"Sx00-8018-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"53411","type":"LOCAL"},{"code":"207593","type":"LOCAL"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":1170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 53411 = Hospital System Supply Identifier | 207593 = Lawson ID"}]},{"description":"HEAD 36MM 8018-36-04","code_information":[{"code":"Sx00-8018-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134223","type":"LOCAL"},{"code":"207594","type":"LOCAL"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":1170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 134223 = Hospital System Supply Identifier | 207594 = Lawson ID"}]},{"description":"HEAD 36MM 8018-36-05","code_information":[{"code":"Sx00-8018-036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"134224","type":"LOCAL"},{"code":"207595","type":"LOCAL"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":1170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 134224 = Hospital System Supply Identifier | 207595 = Lawson ID"}]},{"description":"IMP HIP FEM HD 12X14X40MM 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200MM","code_information":[{"code":"Sx00-8114-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302564","type":"LOCAL"},{"code":"395527","type":"LOCAL"}],"standard_charges":[{"gross_charge":19236.0,"discounted_cash":10002.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 302564 = Hospital System Supply Identifier | 395527 = Lawson ID"}]},{"description":"IMP HIP FEM STEM SZ4 130MM","code_information":[{"code":"Sx00-8114-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302565","type":"LOCAL"},{"code":"395528","type":"LOCAL"}],"standard_charges":[{"gross_charge":6615.0,"discounted_cash":3439.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 302565 = Hospital System Supply Identifier | 395528 = Lawson ID"}]},{"description":"IMP HIP FEM STEM CPT SZ4 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230","code_information":[{"code":"Sx00-8114-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300246","type":"LOCAL"},{"code":"534455","type":"LOCAL"}],"standard_charges":[{"gross_charge":19236.0,"discounted_cash":10002.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 300246 = Hospital System Supply Identifier | 534455 = Lawson ID"}]},{"description":"IMP HIP FEM STEM REV SZ4 260","code_information":[{"code":"Sx00-8114-004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"300247","type":"LOCAL"},{"code":"534456","type":"LOCAL"}],"standard_charges":[{"gross_charge":19236.0,"discounted_cash":10002.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 300247 = Hospital System Supply Identifier | 534456 = Lawson ID"}]},{"description":"IMP HIP FEM STEM CPT 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180MM","code_information":[{"code":"Sx00-8114-013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"302566","type":"LOCAL"},{"code":"395529","type":"LOCAL"}],"standard_charges":[{"gross_charge":19236.0,"discounted_cash":10002.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 302566 = Hospital System Supply Identifier | 395529 = Lawson ID"}]},{"description":"IMP HIP FEM STEM CPT SZ XSM","code_information":[{"code":"Sx00-8114-040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"},{"code":"284420","type":"LOCAL"},{"code":"524288","type":"LOCAL"}],"standard_charges":[{"gross_charge":6615.0,"discounted_cash":3439.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: WCH LOCATION | 284420 = Hospital System Supply Identifier | 524288 = Lawson ID"}]},{"description":"IMP HIP FEM STEM CPT SZ 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